Cardiovascular disease claimed 831,272 lives in the United States in 2006, accounting for one of every 2.9 deaths, according to the American Heart Association. In three different clinical trials, Toshiba America Medical Systems is validating the use of CT and ultrasound technology for noninvasive, earlier detection of the signs of heart disease.

The three trials include: CorE 64, the largest trial ever initiated evaluating the use of 64-detector row CT, which investigated the use of multidetector-row CT as the primary diagnostic tool for detecting cardiovascular diseases and disorders; faCTor64, which evaluates the use of CT angiography (CTA) and echocardiography as diagnostic tools; and CORE 320, which examines whether the combination of CTA and myocardial perfusion can identify coronary stenoses of 50 percent or less (by quantitative coronary analysis) that correspond to SPECT perfusion defects.

In all three cases, validating the technology for noninvasive, early diagnosis of cardiovascular disease or defects could change how cutting-edge technology improves outcomes. Rich Mather, senior manager, Clinical Programs at Toshiba Medical Research Institute USA, says, “We expect CORE 320 findings to affect the way the medical community views the role of dynamic volume CT in the diagnosis and treatment of life-threatening diseases. When these results are available they could eventually have an impact on the way patients are diagnosed and treated.”

The CORE 320 study, which recently commenced at Johns Hopkins University School of Medicine, compares the effectiveness of 320-detector row CT angiography and perfusion with that of the combination of SPECT and coronary catheterization in identifying coronary stenoses with an associated perfusion defect. Johns Hopkins will serve as the core site for CT, while Brigham and Women’s Hospital in Boston will be the core site for SPECT. Mather explains that the multisite approach is designed to provide statistically reliable data. He says, “The trial’s design calls for an international, multicenter approach, bypassing the limitations of study bias and those associated with focusing on one geographic area and/or small patient populations.”

Toshiba’s faCTor64 study looks at the use of both 64-detector row CT and echocardiography in diagnosing coronary heart disease (CHD). Around 300,000 U.S. residents per year experience their first symptoms of CHD as either heart attack or sudden death, but there is no accepted detection test for the presence of the disease. On the CT side, the study, performed in conjunction with Intermountain Healthcare in Salt Lake City, will look at 1,000 patients over the age of 50, using Toshiba’s Aquilion® 64-detector row CT system to capture both obstructive and nonobstructive CHD data to determine the best method of treatment.

The faCTor64 research picks up where Toshiba’s CorE 64 study left off; the CorE 64 results,1 which were published in the November 27, 2008, issue of the New England Journal of Medicine, investigated CT’s ability to detect disease, as compared with that of diagnostic catheterization. The faCTor64 work not only focuses on detection of the disease in asymptomatic patients, but also assesses whether the ability to detect and treat coronary-artery disease has improved patient outcomes. “We believe the results of faCTor64 will improve the diagnosis and treatment of diabetic patients, who are more likely to develop CHD,” Mather explains. “This study will provide optimal information to guide patient management and measure clinical outcomes.”

In a recently announced faCTor64 substudy known as Speckle Tracking by Echo, Intermountain Healthcare will also examine the use of Toshiba’s Wall Motion Tracking (WMT) ultrasound technology to evaluate asymptomatic patients with diabetes for CHD. Using echocardiography to evaluate patients could help physicians detect disease noninvasively at its earliest stages, bypassing more costly procedures like catheterization.

WMT evaluates one region of the heart muscle to show how it is moving in relation to other regions, revealing even subtle abnormalities; 300 patients have already been enrolled in the substudy. J. Brent Muhlestein, MD, director of cardiovascular research at Intermountain Healthcare and the study’s lead investigator, says, “So far, Wall Motion Tracking shows significant promise as an inexpensive, noninvasive tool to detect subtle differences in how regions of the heart muscle are working.”

All three studies are aimed at providing additional information to direct patient management and track clinical outcomes. Donald L. Lappe, MD, chief of cardiology at Intermountain Healthcare, says, “Patients with diabetes have a two-to-four times greater risk of cardiovascular disease than nondiabetic patients. The ability to detect CHD in at-risk, asymptomatic patients will have a significant impact on the ability to improve their cardiac conditions and will help save lives.”

Reference
1. Miller JM, Rochitte CE, Dewey M, et al. Diagnostic performance of coronary angiography by 64-row CT. N Engl Med. 2008;359(22):2324-2336.

Reference
1. Miller JM, Rochitte CE, Dewey M, et al. Diagnostic performance of coronary angiography by 64-row CT. N Engl Med. 2008;359(22):2324-2336.

Click here to download a printer-friendly version.

Today’s economic environment makes it increasingly challenging for physicians and technologists to travel to educational events. Robb Young, senior manager in the CT Business Unit for Toshiba, explains that this obstacle inspired the company to begin sponsoring webinars on applications for its imaging technology. “Webinars are easier for people to access,” he says. “We can do them during the day, and we can make the expertise of a particular speaker available to a broader audience. A webinar can also be saved online, so if people missed it, they can easily access the information later.”

Toshiba’s first webinar in 2010 featured S. Bruce Greenberg, MD, professor of radiology and pediatrics at Arkansas Children’s Hospital, presenting on how radiology professionals and clinicians can leverage 320-detector row CT to reduce sedation needs and radiation exposure for patients while providing them with high-quality diagnostic images.  This webinar was so well received, that Dr. Greenberg conducted a second session in late February.  “We’re focusing on the needs in the market that drove the development of this technology,” Young says. “In pediatrics, obviously, that’s being able to image patients quickly at a low dose.”  This CME-accredited webinar will be available online in April.  At that time, please visit the following site to view the webinar and receive educational credits http://www.ceconcepts.net/CT/ .

Webinars planned for later in the year include sessions on using 320-detector row CT for cardiac care and stroke triage and diagnosis, as well as on applications and technology for non-contrast MRI. The webinars are each an hour long, are free to all attendees, and are accredited by the Accreditation Council for Continuing Medical Education. Each is worth one CME credit.

“We find these events are particularly beneficial for those who are looking at new applications of a technology, or who want to understand a technology better—especially because they get to hear about it from a user,” Young says. “The webinar format allows us to get the information out to those who need it more quickly and easily.”

Click here to download a printer-friendly version.

At this year’s annual scientific meeting of the American College of Cardiology (ACC), which takes place on March 14–16 in Atlanta, Toshiba (booth #1944) will showcase a range of advances in and enhancements to its cardiac-imaging technology.  Following is an overview of what Toshiba will showcase:

Infinix-i Hybrid Lab

When performing patient procedures in a hybrid setting, it is critical that the imaging system provides the flexibility to quickly and easily access both the patient and ancillary equipment. Toshiba will showcase its Infinix™ VF-i vascular X-ray system with 12” x 12” flat panel detectors and CAT-880B hybrid catheterization table, designed to create a best-in-class hybrid suite.  The new mid-sized 12” x 12″ flat panel detector expands the versatility of the Infinix-i line that features a five-axis C-arm positioner and enables unprecedented patient access and coverage. Along with the new mid-sized detector, the Infinix-i five-axis systems are now available with the new CAT 880B tilt/cradle hybrid catheterization table. This table is designed to allow greater positioning flexibility and patient access during imaging and surgery. The table functionality, with side-to-side cradle and head-to-toe tilt, permits clinicians to angle the table in the optimal position to quickly and comfortably complete procedures. The system on display will also include ancillary equipment typically used in a hybrid suite.

Cardiac Ultrasound Capabilities

The cardiac capabilities of Toshiba’s ultrasound technology will also be featured. The Aplio Artida™ system is a dedicated cardiac system which provides unique 3D Wall Motion Tracking, allowing physicians to rapidly identify wall-motion defects and the timing of cardiac events, as well as real-time, multiplanar reformatting for assessing global and regional left ventricular function. Also on display is the new Aplio™ MX system, which is midsized and cart-based for better portability. Aplio MX is a multi-modality system which includes Differential Tissue Harmonic Imaging, for better results with bariatric patients; ApliPure, which enhances image clarity and detail definition; Advanced Dynamic Flow, which shows flow with directional information for even the smallest vessels.

Cardiac CT Software Enhancements

CT will highlight cardiac-software enhancements for the Aquilion^® ONE and Aquilion Premium, including new ONE Beat Prospective Reconstruction, which shortens the interval window and reduces radiation exposure time, reducing dose by 21 percent; Real Time Beat Control, which calculates the running real-time average of the heart rate to predict the next beat more precisely (and thus, to time the scan more accurately); and optimizing timing for ^SUREStart, which accurately determines contrast uptake time for a better image. Wide Volume Cardiac Protocol on the Aquilion ONE, a work-in-progress enhancement, will enable clinicians to image the entire heart, lungs, and aorta in two rotations.

Cardiac MR

The wide range of cardiac MR capabilities on the Vantage Titan™ and Vantage Atlas^® systems will be highlighted. The Vantage MRI product line offers a range of advanced cardiac capabilities, including a cardiac coil for the Vantage Titan and noncontrast imaging for patients with renal insufficiency.

Click here to download a printer-friendly version.

When patients have to have any diagnostic imaging exam, they are understandably nervous.  Often times the anxiety they feel comes from thinking that a particular exam is going to be difficult, time consuming or uncomfortable.  Toshiba has developed its technology with patients in mind and incorporates many patient friendly features into its systems.  At this year’s RSNA, Toshiba highlighted its patient friendly features.

Magnetic Resonance

For patients undergoing an MR exam, discomfort from claustrophobia and the loud noise of the magnet are among the highest complaints.  To address this, Toshiba developed the Vantage Titan^TM MR, which features a large 71-cm aperture and open bore, offering the industry’s largest clinical field-of-view (55×55×50 cm).  The bore’s diameter reduces the feeling of claustrophobia.  Titan’s ultra short, open bore was designed to increase comfort and improve the imaging of all patients, especially those who are claustrophobic and/or bariatric.  The open bore’s larger diameter enables facilities to scan bariatric patients with greater ease and provides patients with a greater feeling of openness to reduce claustrophobia.

Toshiba’s Pianissimo^TM technology reduces noise by up to 90 percent, making Toshiba’s MR systems the quietest available.  Since the patient experiences lower noise levels with Pianissimo, patients stay more relaxed during exams and fewer motion artifacts are acquired, which helps improve image quality.  Useful for imaging pediatric patients, Pianissimo helps technologists image patients more successfully and reduces repeat exams.

With all of the concern surrounding gadolinium, Toshiba’s proprietary contrast-free MRA techniques enable safer MRA imaging of patients with known renal compromise. These techniques include Fresh Blood Imaging (FBI) for evaluating peripheral vascular diseases of the lower legs and extremities; Contrast-free Improved Angiography (CIA) for easier visualization of smaller vessels; Time-Spatial Labeling Inversion Pulse (Time-SLIP) for evaluating hemodynamic, functional assessments, and visualization of vascular structures; and Time Space Angiography (TSA) to create non-contrast time-resolved imaging with high temporal resolution.  Contrast-free techniques are safer for patients with renal conditions and require less set-up time, so the overall MR exam is completed faster, without compromising image quality.

Computed Tomography

The Aquilion® ONE was specifically developed with patients in mind.  Not only is the comprehensive exam much faster than traditional CT exams – 0.35 seconds versus conventional helical CTs that can take approximately 10 to 12 times longer – but also radiation exposure is dramatically reduced because of volume acquisition.  These patient benefits are especially important during neuro and pediatric procedures.

When a patient comes to a hospital’s emergency department exhibiting stroke symptoms, it can take hours to diagnose and treat the patient when time is of the essence. Toshiba’s Aquilion ONE dynamic volume CT system has the ability to improve the quality of life for patients with neurological symptoms, especially related to stroke, by reducing diagnosis time to minutes. In fact, the system allows physicians to reduce diagnosis time for life-threatening conditions, such as a stroke, from hours or days to minutes. Unlike any other CT system available, the Aquilion ONE covers up to 16 cm of anatomy using 320 ultra high resolution 0.5 mm detector elements to image an entire organ, including the brain, in a single rotation. It can show the organ’s dynamic blood flow and real-time function.  The ability to see dynamic function, such as blood flowing through the brain, is critical for stroke patients in emergency settings and enables rapid and accurate diagnosis when time is critical.

Another reason to select dynamic volume CT is for its pediatric applications.  The Aquilion ONE can significantly lower patient radiation dose exposure and decrease the sedation needed for exams.  Traditionally, when children are imaged using multi-detector CT, sedation is required to keep the patient still long enough to obtain a clear diagnostic image.  The Aquilion ONE’s fast exam time means less patient sedation is required. The system also features Toshiba’s ^SUREExposure™ Pediatric software, which automatically takes inputs on the size and age of each patient and tailors radiation dose to achieve the best and safest image quality for each exam. The software uses protocols selected based on the patient’s age, size and type of exam to ensure patients receive only the radiation required to obtain a clear diagnostic image.  ^SUREExposure Pediatric software comes standard on all Aquilion products.

X-ray Vascular

CT is not the only modality in which radiation is a concern.  Toshiba’s Infinix-i product line incorporates features that help to reduce exposure.  For example, the systems come with fluoro dose level settings and fluoro pulse rate settings.  Toshiba offers the industry’s widest range of pulse rates, which means that physicians have the ability to reduce flyoro pulse rate and fluoro dose level in an exam, providing two quick methods of reducing radiation exposure to the patient.  Additionally, Toshiba’s lateral plane variable isocenter on its biplane systems saves time and exposure.  During biplane positioning, the user will fluoro frontal plane and adjust table panning to center the part of interest.  Next, they will fluoro the lateral plane and adjust lateral isocenter to match the frontal set-up.  No additional fluoro is needed.  Not only does this cut down on fluoro exposure, but it also speeds the exam time, reducing the risk to the patient.

Infinix-i systems also provide the greatest anatomical coverage and patient access in the industry, providing more efficient and safer patient care.  Greater anatomical coverage means that the system moves around the patient, rather than moving the patient.  Moving the patient can introduce greater risk.

The Infinix-i’s tables also are more patient friendly.  Not only are the systems’ table weights the highest in the industry at 550 lbs., but also the tables include thicker pads complete with Tempur-Pedic^® technology, making extended procedures more comfortable.  Also, the new the CAT-880B hybrid catheterization table introduced at RSNA offers the lowest table top height of any catheterization table in the industry.  Toshiba has even introduced accessories that expand the width of the system tables to accommodate larger patients and make the exams more comfortable.

Ultrasound

The move toward portability in ultrasound is helping physicians deliver more comfortable patient care.  The ability to bring a diagnostic imaging system to the patient can often mean that someone already in discomfort does not have to be moved in order to be scanned.

In addition to the Viamo handheld system, Toshiba has continued its focus on portability by introducing the Aplio MX.  Thirty percent lighter than traditional cart-based systems, the Aplio MX enables hospitals to complete advanced ultrasound exams, usually performed with larger systems, on a more portable system without sacrificing quality.  Furthermore, it enables medical staff to easily bring the system directly to the point-of-care.  For example, if someone is on a gurney and should not be moved, medical professionals can easily transport the MX to the patient’s location and get a high quality exam.

Toshiba’s Aplio MX ultrasound system includes:

• 4D imaging to produce high resolution renderings and arbitrary volume cuts in real-time or offline allowing virtual reconstruction in formats similar to CT and MRI.
• Differential Tissue Harmonic Imaging for better imaging of difficult-to-image patients, like bariatric, without sacrificing resolution to give superior border and tissue definition.
• ApliPure to enhance both image clarity and detail definition with real-time compounding technology to simultaneously perform spatial and frequency compounding during transmitting and receiving.
• Advanced Dynamic Flow to provide color Doppler imaging at an unprecedented level and show flow with directional information for even the smallest vessels.
• Precision Imaging to provide more detailed ultrasound images by capturing information from multiple lines to improve definition of the structure and minimizing noise and clutter.
• Elastography to enable a non-invasive medical imaging technique that evaluates tumors based on their stiffness (elasticity) compared to normal tissue.
• MicroPure to help physicians detect micro-calcifications using ultrasound, an imaging technique that is less strenuous on the technician and the patient than mammography, the current gold standard.

Click here to download a printer-friendly version.

Read our latest RSNA press releases here.

At this year’s RSNA, the AHRA: The Association for Medical Imaging Management and Toshiba announced the six recipients of the second annual Putting Patients First grant program.

This year’s Putting Patients First grant program was expanded to include imaging centers and three additional grants specifically for pediatric programs. The six recipients were selected by the AHRA selection committee to receive up to $7,500 grants to fund programs, trainings or seminars aimed at improving patient care and safety in diagnostic imaging.

In its second year, this program has expanded its scope to include improving the imaging of children.  Children have special imaging needs – exposure to radiation and contrast are concerns within the industry, as is ensuring that children are well prepared for the imaging experience.  Putting Patients First will help facilities address these very specific needs.

“Grant programs like Putting Patients First are critical given today’s health care environment and the pressures hospitals face due to limited resources and other financial challenges,” said Debra A. Lopez, AHRA president, CRA, FAHRA. “This year’s winning programs demonstrated quality and innovation in patient care. They will make significant improvements to patient care and better the imaging experience for physicians and patients, alike.”

The programs funded by the AHRA/Toshiba Patient First grants include:

Children’s Healthcare of Atlanta at Egleston – Use of Bismuth Shields in All CT Exams

• Several recent publications report radiation dose reduction benefits when using bismuth shielding for pediatric patients undergoing multidectector CT. Therefore, Children’s Healthcare of Atlanta at Egleston will implement the use of bismuth shields in all patients undergoing CT examinations. Implementation of this shielding program will entail staff training, purchase of bismuth breast and thyroid shields, ongoing review of images, development of resident and parental educational programs, and a cost analysis.

Community Health Network – Pediatric CT Imaging Simulation Program

• By enabling pediatric patients to better understand the CT imaging process, radiation dose will effectively be reduced, patient comfort will be improved and the overall imaging experience will be safer. Therefore, Community Health Network will create an Internet-based simulation program to educate pediatric patients and their caregivers about the diagnostic imaging process (focused on CT).  By incorporating audio, avatars and animation through a user-friendly computer program, patients will know what to expect of the imaging process and be more comfortable and compliant during the procedure.

Memorial Hermann Outpatient Imaging Division – Improved Process Program

• Memorial Hermann’s goal is to emphasize the importance of keeping radiation dose during CT procedures as low as reasonably achievable for pediatric patients, while still maintaining good image quality. It also recognizes the need for more education for the technologists and pediatricians on pediatric radiation safety. Therefore, Memorial Hermann will implement the Improvement Process Program to: 1) document the dose electronically PACs; 2) scan once – multiphase scanning is usually not necessary in children; 3) reduce or “child-size” the amount of radiation used; 4) audit and evaluate image quality monthly; and 5) provide physician and technologist continued education.

Highline Medical Center – Improvement Project for Scheduling Inpatients for Imaging Exams

• One of Highline Medical Center’s goals is to provide a patient-centered environment that personalizes, humanizes and demystifies patient care. Therefore, Highland Medical Center is undertaking an improvement project to develop, implement and spread a process for scheduling inpatients for imaging exams to accomplish safer patient care through: 1) better communication among the staff caring for the patient; 2) increasing involvement of the patient in his/her own care; 3) better coordination between services for tests and treatments leading to streamlined clinical pathway; 4) eliminating delayed/missed or incorrect imaging exams; 5) improving patient flow to potentially decrease overall length of stay; and 6) having imaging techs rounding on patients prior to high risk, invasive or advanced imaging procedures.

Shields Health Care – Understanding and Reducing Patient Anxiety

• Shields Health Care wants to engage the patient in a common language that educates and reduces patient anxiety. Therefore, Shields Health Care will develop multi-lingual web-based tools as well as professional staff training. Phase one of the program will be to research causes and develop solutions; phase two will be to implement and cross train professionals and technical staff; and phase three will be dedicated to reflection on lessons learned and measuring program effectiveness and outcomes.

St. Patrick Hospital – Interactive Utility to Improve the Imaging Process

• Inaccurate or inappropriate exam orders contribute to increased costs to patients, staff and facilities in terms of dose, money and time. Therefore, St. Patrick Hospital will create on its intranet Web site an interactive utility that is readily accessible to all staff to provide guidance regarding appropriate imaging studies and help facilitate clear exam orders to maximize the value of imaging studies. Once the program is developed for intranet users, St. Patrick Hospital will provide a condensed version of the utility on its hospital Web site with more links to helpful information in order to improve patient understanding of the process. This version also will be a tool used by clinicians and staff when discussing exam specifics with patients.

Click here to download a printer-friendly version.

Read our latest RSNA press releases here.

According to the March of Dimes, congenital heart defects affect more than 25,000 infants every year in the United States.

Imaging children has many challenges due to their unique imaging requirements compared to adults. The best benchmark for a pediatric CT scanner should include the ability to acquire images as fast as possible, with the best image quality, and at the lowest possible x-ray dose.

Aquilion ONE can capture whole anatomical regions in a single rotation of the gantry. This ability can dramatically reduce the amount of contrast, radiation and possibly the need for sedation. Aquilion ONE also comes equipped with ^SUREExposure Pediatric which incorporates the unique imaging requirements of pediatric imaging and ensures the lowest possible dose while maintaining diagnostic image quality.

Case: CTA of the chest to evaluate congenital heart defect in a 9 month old infant with respiratory distress noted at birth.

Scan Parameters: 80kV, 25mAs, 0.35 second rotation.

3D volume rendered and MPR views clearly demonstrate this double aortic arch causing stenosis of the left main stem bronchus, most likely causing the infants continued respiratory distress. 3D images can give surgeons a roadmap for intervention, making it safer and saving time. No sedation was need for this scan due to the very short scan time of 0.35 seconds.