Ultrasound – Carotid Intervention
As with many other conditions, ultrasound is often the first modality physicians turn to when evaluating a patient presenting with stroke symptoms. It’s a key tool for evaluating the carotid arteries to identify the presence and type of plaque buildup the patient could have. Two key Toshiba features for ultrasound are particularly useful in stroke imaging.

Precision Imaging: This technology enhances image clarity and resolution to help physicians visualize plaque in the carotid arteries. Precision Imaging increases diagnostic confidence by providing more detailed ultrasound images so physicians can quickly determine the next steps in a patient’s treatment. As a multiresolution signal processing technology, it not only evaluates images line by line but also includes information from adjacent lines to enhance the amount of information obtained. As a Toshiba exclusive software, Precision Imaging’s ability to capture information from multiple lines improves the definition of the structure, provides more detail and minimizes noise and clutter.

Advanced Dynamic Flow™: Advanced Dynamic Flow improves very high resolution for greater diagnostic confidence for vascular structures. This sensitivity helps to better visualize the degree of stenosis in the carotid arteries. Using the same ultra-high bandwidth normally used only in B-mode for doppler signal processing, Advanced Dynamic Flow simultaneously provides both high spatial resolution and high frame rates to accurately display flow with directional information, even in tiny vessels.

CT – Faster Stroke Assessment
When a patient comes to a hospital’s emergency department (ED) 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 with half the dose of conventional CT.

The Aquilion ONE allows physicians to reduce diagnosis time for life-threatening conditions such as 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. Coverage can also be collimated to a smaller area to reduce the dose to the patient.

This Neuro ONE acute stroke imaging protocol on Aquilion ONE combines non-contrast CT, cerebral blood flow analysis and four-dimensional digital subtraction angiography (DSA) into a single exam. By combining these exams into a single low-dose protocol, full stroke workup can be performed in less than five minutes.

Magnetic Resonance – High-Sensitivity Stroke Imaging
MRI is particularly beneficial for diagnosing acute ischemic stroke because it is highly sensitive to detecting microscopic changes in blood and oxygen in the brain. Toshiba MR integrates other techniques that further enhance MR’s role in stroke diagnosis.

Non-contrast techniques: Not only are there safety concerns when imaging with gadolinium, but also having to add contrast injections to a stroke evaluation can take time that is not a luxury in these emergency situations. Toshiba offers the most robust suite of non-contrast techniques that are beneficial for stroke analysis. For example, the V-TRACE sequence can shorten brain imaging time.

V-TRACE Sequence: This non-contrast MRA sequence available on all Vantage Titan™ and Vantage Atlas® systems, streamlines MRA brain imaging. The sequence acquires four image contrasts in one sequence, providing an imaging application for visualizing slow- and fast-flow vessels separately and together, as well as the brain tissue surrounding the vessels.

V-TRACE MRA is a dual-echo 3D FE sequence in which the first echo is acquired using Time-Of-Flight (TOF) and the second echo is acquired using Flow Sensitive Black Blood (FSBB). The sequence combines the advantages of both techniques to produce MRA images that depict blood vessels with both high and low velocity. The sequence design reduces the Specific Absorption Rate (SAR), which is a measurement of heat generated to the body during a MRI. Additionally, the TOF data can be used to evaluate the brain parenchyma. The images produced by the V-TRACE sequence improve the speed and accuracy of diagnosis.

Patient-friendly features: Toshiba’s patient friendly MR features make imaging easier for the patient. Several features reduce the feeling of claustrophobia that often accompanies MR exams. For example, the Titan’s large bore allows patients more room during the exam. Also, Toshiba’s head coil – important in the imaging of stroke – has 10 elements and very high signal to noise, which means it is not always necessary to utilize the top of the coil to image, reducing claustrophobia during an exam.

Infinix™-i Biplane Vascular X-ray System – Efficient Stroke Treatment
Toshiba’s Infinix-i biplane system has been developed with a number of tools to provide methods for neuro-interventionalists to develop treatment plans for patients more quickly. There are four key components of the system that make it ideal for stroke analysis.

Two 12×12-inch detectors: The midsize flat-panel detectors are ideal for brain imaging because they allow physicians to get two complete views of the cerebral vascular anatomy with each contrast injection, which not only helps to minimize the contrast load to the patient, but also provides better visualization due to the increased anatomical coverage when compared to two small detectors. Additionally, these midsized detectors allow physicians to obtain steeper compound angle views than can be obtained on systems with two large detectors.

3D angio visualization: This technology provides a three-dimensional image volume that can be rotated and manipulated in real time to ideally sort out superimposed vascular anatomy. Additionally, the two-dimensional multiplanar reformations enable physicians to dissect the image data from a variety of angles.

Variable isocenter: This key feature can dramatically improve patient safety during imaging. For example, some patients who are experiencing an aneurysm or subarachnoid hemorrhage may need a ventriculostomy to monitor and control intracranial pressure. Changing the table height in order to get the best imaging angles can present a dangerous challenge for physicians, because changing the table height can negatively impact the intracranial pressure and potentially injure the patient. Toshiba’s lateral plane variable iso-center feature allows optimal positioning for imaging the brain, eliminating the need for table height adjustment, as is done on all competitive biplane angiographic systems. Physicians do not have to raise or lower the table to get the best angle, eliminating simple positioning as a concern for causing change in intracranial pressure.

Five-axis positioner: Toshiba’s Infinix-i C-arm offers unprecedented patient access with a C-arm five-axis positioner that allows head-to-toe and fingertip-to-fingertip coverage. The freely moving components, ergonomically friendly design and five-axis positioner enable physicians to obtain optimal angles for neurological diagnosis and interventional procedures without repositioning the patient. Neuro-interventions typically are done with the patient under general anesthesia or heavy sedation, requiring anesthesia support during the procedure. The five-axis c-arm provides multiple setup configurations to provide unrestricted access to the headend of the table for patient care while preserving biplane projection capabilities.

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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.

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In early February, the new portable Viamo™ ultrasound system from Toshiba America Medical Systems received FDA clearance. The Viamo, which was introduced at the 2009 meeting of the RSNA in Chicago, combines the portability of a laptop system with advanced radiology features, according to Erin Owen, product manager in Toshiba’s ultrasound business unit.

“The Viamo comes standard with Toshiba’s advanced features,” she says. “Not only does the system have the imaging features of our high-end products, but also its transducers are interchangeable and can be used with our advanced systems.” The ability to interchange transducers improves productivity and saves money for current Toshiba customers, while new customers will be able to use Viamo transducers with any other Toshiba ultrasound systems that they might implement in the future.

The Viamo weighs less than 20 pounds, making it possible to carry by hand, and is ideal for a range of patient exams, including general, pediatric, emergency, obstetrical/gynecological and vascular sonography. It is also optimized for bedside use, such as assessing blood flow during a transplant. Image quality and color flow are comparable to those of more expensive, cart-based systems, and a simple touchscreen interface, programmable in both panel and tablet modes, ensures ease of use. “The Viamo has radiology-specific features you wouldn’t expect from a handheld unit,” Owen says, “but at only 18 pounds, it’s in the same weight class as other laptop ultrasound systems.”

“The Viamo is specifically designed to provide advanced radiology capabilities in a portable system, creating more comfortable exams for patients,” said Owen. “Providing the best value in the handcarried segment, the Viamo delivers high-quality images for numerous clinical applications.”

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An ectopic pregnancy is a condition in which an abnormal pregnancy occurs and the fertilized egg attaches to a region outside of the womb (uterus). It is estimated that 20 of every 1,000 pregnancies are ectopic. 95% occur in the ampulla or isthmus of the fallopian tube, 2-3% are interstitial, while cervical, ovarian, and abdominal ectopics are rare. While there is no way to save the fetus during an ectopic pregnancy, quick treatment of this condition is necessary as continued growth of the egg may cause damage or rupture of the attached region.

Clinically, patients present 6-8 weeks after their last menstrual period, however it may be later. Classic symptoms include amenorrhea followed by vaginal bleeding, and localized pelvic pain. If the fallopian tube ruptures, the patient may present with sharp stabbing pain in the pelvis, vaginal bleeding, dizziness, and possible hypotension.

Ultrasound is a non-invasive imaging procedure used to visualize the condition of a pregnancy. Abdominal and transvaginal ultrasound is often used to visualize the intrauterine gestational sac – absence of this intrauterine gestational sac suggests the presence of an ectopic pregnancy.

Case Study: Abdominal ultrasound imaging of the pelvis was used to diagnose this right-side ectopic pregnancy.
Technology: Toshiba Aplio XG ultrasound.

Patient History: A 25 year old female presented to the emergency room with right lower quadrant pain, nausea, and vomiting. The patient was gravid 3 Para 1. The patient’s quantitative beta-hcg level was 1,843 IU. The patient’s clinical history was significant for prior ectopic pregnancy.

Ultrasound imaging of the pelvis shows a normal appearing uterus with a normal endometrial stripe. No intrauterine pregnancy is noted. The images of the right adnexa show a right paraovarian cystic lesion with thick echogenic rim. A small amount of free fluid is located in the posterior cul-de-sac.

The ultrasound findings, combined with the patient’s beta-hcg levels, are diagnostic of a right sided ectopic pregnancy. The ectopic gestation contains a yolk sac and possibly a fetal pole; however, no embryonic cardiac activity was identified.

Image Gallery

Normal uterus with abnormal right ovary show paraovarian cyst small pocket of fluid in the posterior cul de sac. Images courtesy of Amy Rutledge, RDMS Chief Sonographer, University Hospital Case Medical Center

Reference:
E A. Lyons, The first trimester, C M Rumack, Diagnostic Ultrasound, Third edition 2005, Obstetrics and Gynecology, Volume 1, Berman, Craig, and Kawamura.

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Echocardiography is a valuable tool in the diagnosis of coronary artery disease, but evaluation of myocardial function using 2D echocardiography relies primarily on visual detection of wall-motion abnormalities. In 2009, Toshiba America Medical Systems introduced a proprietary 3D Wall Motion Tracking (WMT) tool for its Aplio™ Artida ultrasound system, which helps clinicians quantify the function of the left ventricle in 3D—including left-ventricular ejection fraction, volume, and strain information.

“3D Wall Motion Tracking allows sonographers and physicians to quickly and accurately identify wall motion defects and the timing of cardiac events,” Berkeley Cameron, cardiac marketing manager for Toshiba, explains. “This greatly improves the detection of wall motion abnormalities in many cardiac disease states and Cardiac Resynchronization Therapy (CRT), and helps physicians optimize pace maker settings.”

In addition, the tool can be useful in diagnosing heart disease in women. Although stress studies have been shown to detect heart disease fairly accurately in men, women sometimes experience an increased risk of false-positive results. “Usually, for women, physicians want to do stress echocardiography instead of a treadmill study,” Cameron says. “That’s one area where Wall Motion Tracking is particularly useful for women. Having quantitative data help make the diagnosis more accurate.”

The response from clinicians using the tool has been enthusiastic, Cameron says. “We’ve gotten quite a bit of positive feedback,” she notes. “The clinicians using WMT feel it’s going to help them diagnose coronary artery disease. Anything they can do to diagnose disease earlier and to be more accurate—to make echocardiography less subjective—is a big benefit.”

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While efficiency has always been important in health care, the changes we see in today’s environment are requiring the medical community to be even more diligent.  Many are starting to recognize that the right equipment can make important differences.  At this year’s RSNA, Toshiba showcased how its systems are helping health care professionals meet the demands for efficiency without sacrificing quality.

Magnetic Resonance

The patient-focused features of the Vantage Titan™ improve exam efficiency and accuracy while mitigating issues around imaging claustrophobic and bariatric patients.  The Vantage Titan features a large 71-cm aperture open bore and offers the industry’s largest clinical field-of-view (55×55×50 cm).  The bore’s diameter enables technologists to scan patients with greater ease and reduces the feeling of claustrophobia.  Toshiba’s patented Pianissimo™ technology, which reduces acoustic noise by as much as 90 percent, is also increasing the comfort level of patients during exams.  Improving comfort level is critical because it often reduces the need for re-scans, thus improving efficiency.

St. Anthony Hospital in Gig Harbor, Wash., has experienced these benefits first hand.  “The Toshiba Titan has been the workhorse MR system for us and is able to accommodate the wide variety of MR exams we perform each day,” said Gary Leslie, MRI technologist at St. Anthony.  “We are imaging multiple patients a day and have received direct patient feedback that the system is quieter and feels less claustrophobic than other MR systems.  This has helped us to greatly improve exam efficiency and department throughput.”

Additionally, the system’s Atlas integrated coils allow physicians to perform multiple exams without repositioning the patient and also enable feet-first imaging for feet-to-shoulder exams.  This means a more comfortable exam experience and results in enhanced workflow and technologist productivity.  Also, Toshiba’s SPEEDER parallel imaging allows for increased acquisition speed and reduced examination times.

X-ray

Today’s emergency departments are challenged to provide rapid, accurate diagnoses for a variety of patient conditions when time is of the essence. Toshiba’s RADREX™-i digital radiographic system is designed to provide the features emergency departments require to offer the highest level of patient care.

The comprehensive RADREX-i offers a 600-lb. table weight limit, 600 kHU X-ray tube and an 80-kilowatt generator, allowing hospitals to image a variety of patients, including bariatric. The X-ray system enhances workflow with the RexView, a color LCD screen located on the overhead tube crane (OTC). Since the image appears on the OTC, technologists have immediate access to review the image and determine if they have what is needed for diagnosis, ultimately reducing exam time and increasing the chance of a positive patient outcome.

The RADREX-i’s automated features also save time in emergency settings by automating exam selection and X-ray positioning. These features include:

• Auto-tracking to eliminate the need to manually position the X-ray tube detector by providing synchronization for table and wall-stand tracking
• Auto-collimation to save crucial time for the patient and technologist by automatically selecting the correct collimation size for the patient’s body part
• Auto-program to eliminate the need for the technologist to manually select the program on the generator by automatically selecting the correct program
• Auto-center stop to provide visual guidance for fast, simple detector centering

St. Luke’s Community Hospital in Ronan, Mont. uses the RADREX-i in its emergency department.

“When treating emergency patients, acting quickly is critical,” said Steve Sivak, radiology manager, St. Luke Community Hospital. “The advanced features of the RADREX-i help us streamline workflow and accelerate throughput, providing a tremendous benefit to patients when time is limited.”

Ultrasound

Many hand-carried ultrasound systems offer better access to patients when space is compromised, but cannot provide all of the advanced radiology capabilities required to perform exams in today’s demanding ultrasound environment.  Toshiba’s new works-in-progress Viamo™ ultrasound system meets the needs of today’s hospitals by combining portability with high-end radiology features.  Viamo is the industry’s no compromise ultrasound system with advanced radiology capabilities, previously unavailable on hand carried systems.

The Viamo combines the portability of a laptop system with advanced radiology features to deliver outstanding image quality, enhance diagnostic confidence and improve ease-of-use. Developed from a radiology foundation, Toshiba’s Viamo provides the confidence to image patients at bedside, which generally require larger, more expensive cart-based systems. When an immobile patient needs a high-end ultrasound exam, the portable Viamo laptop ultrasound is brought to the patient to improve the patient’s comfort without compromising exam quality.

The new Toshiba Viamo laptop ultrasound system offers:

• Best-in-class imaging capabilities in a laptop size, making it ideal for high-end radiology, vascular, emergency and OB/GYN exams, even at bedside. For example, Viamo is beneficial during liver transplants when medical personnel must image the anastomoses to assess blood flow through the vessels.
• Excellent image quality and color flow comparable to larger, more expensive cart-based systems.
• Ease-of-use with a simple touch-screen interface that is programmable in panel or tablet modes.
• Ability to interchange Toshiba transducers while using the Viamo’s transportation pole, thus improving productivity and flexibility, while saving health care costs by reducing the need to purchase multiple transducers. This unique feature improves productivity and saves money for current customers by using their existing Toshiba transducers on the Viamo.  Additionally, new customers are able to use Viamo transducers with other Toshiba ultrasound systems they may purchase in the future.

Computed Tomography

Overall, Toshiba’s Aquilion® line continues to be focused on exam efficiency and the company has added several new features to help the medical community.  The Aquilion line comes with a host of ^SURETechnologies that automate parts of the exam, which not only provides efficiencies, but also safer exams.  For example, Variable Helical Pitch (vHP) ensures greater workflow efficiency by enabling physicians to complete an exam of more than one anatomical region consecutively – i.e. without stopping to alter the helical pitch of the exam.  Toshiba’s CT line also features items like the iStation, a screen on the gantry that provides automatic exam feedback to the technologist, and a table with a 660-lb. weight limit that also lowers within inches of the ground, enabling patients to sit on the table more easily.

While the entire Aquilion line boasts efficiencies, Toshiba’s Aquilion® ONE is designed for today’s health care environment because it can streamline workflow by providing a more accurate, complete and timely diagnosis with one exam.  The Aquilion ONE can image a patient in 0.35 seconds, whereas conventional helical CTs can take four or five seconds, approximately 10 to 12 times slower.  Beyond its fast acquisition time, the Aquilion ONE can replace several tests with one exam, eliminating the time, cost and staff required to perform additional unnecessary exams.  It also allows physicians to treat at-risk patients immediately and send healthy patients home without additional testing and staff support.

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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.

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The journey from bench to bedside is a long one in medicine, but breast MRI received a boost in March 2007 when the American Cancer Society (ACS) revised its guidelines for breast cancer screening to include annual MRI for high-risk women, a group representing about 2 percent of the US population. That same month, a report¹ on the ACR Imaging Network 6667 trial was published in the New England Journal of Medicine, recommending contralateral breast MRI for women recently diagnosed with breast cancer. In addition, the ACS recommends that women with extremely dense breasts, a personal history of breast cancer, and atypical hyperplasia receive breast MRI at their physicians’ discretion.

Another adjunct breast-imaging modality is poised to assume an even greater role in breast cancer screening and diagnosis. Ultrasound, long used to help evaluate suspicious lesions and cysts and to guide breast biopsies, has been generating a growing list of scientific citations since emerging as a hot topic at the 2006 meeting of the European Congress of Radiology (ECR) for a different reason: elastography.

Numerous studies have indicated that elastography, which uses ultrasound waves to measure the elasticity of tissue, could be a useful diagnostic tool for several cancers, including breast malignancies. Cancerous tissue is less pliant than regular breast tissue; according to the results of one British study presented at ECR 2006,² the sensitivity and specificity of breast elastography are 96 percent and 53 percent, respectively, meaning that the technique could be used to determine whether a lesion is benign or malignant without invasive biopsy. Later that year, a poster presentation³ at the annual RSNA meeting showed similar results.

An article⁴ published in the July 2008 issue of Breast Cancer, “Cost-effective Screening for Breast Cancer Worldwide: Current State and Future Directions,” provided another argument for the use of elastography in breast cancer diagnosis: its affordability. “Clinical results demonstrate that elasticity imaging, even in its simplest and least sophisticated versions, like tactile imaging, has significant diagnostic potential comparable and exceeding that of conventional imaging techniques,”⁴ the study’s authors wrote. “Tactile imaging is one method that has the potential to provide cost-effective breast cancer screening and diagnostics.”⁴

A National Cancer Institute clinical trial to validate the use of elastography in breast cancer evaluation was launched in July of 2008 and is currently recruiting participants.

Meanwhile, ultrasound guidance for breast biopsy and surgery continues to gain momentum. A recent study⁵ published in Breast looks at the use of vacuum-assisted, ultrasound-guided breast biopsy for difficult indications, including lesions with scarring or distortion, and small tumors or microcalcifications. The study indicates that the technique helped patients avoid difficult surgery in 41 of 51 cases. Another study,⁶ published in the August 2009 issue of the American Journal of Surgery, looks at using an ultrasound-guided electrosurgical loop to excise breast lesions, noting that the technique shortened procedure times and allowed incisions to be smaller.

As breast MRI proliferates around the country following the 2007 ACS revisions to its screening guidelines, research into the diagnostic potential of the modality for breast cancer continues apace. The ACS recommendation came with a caveat: The relatively low specificity of MRI could lead to false positives, resulting in unnecessary biopsies. Some hope computer-aided detection could be a solution. A study⁷ published online in September 2009 in European Radiology evaluated the accuracy of a computer-aided detection program against manual interpretation by radiologists, finding that interpretation based on computer-aided detection had a specificity of 86.4 percent. Without computer-aided detection, the specificity of MRI was found to be around 69 percent.

Another European Radiology study⁸ published online in September 2009 looks at the use of MR elastography (MRE), an experimental technique that uses MRI instead of ultrasound to look at tissue elasticity. According to the results of the study, the addition of MRE to conventional MRI of the breast resulted in sensitivity approaching 98 percent, leading the study’s authors to conclude the combination of MRE and contrast-enhanced MRI could increase the diagnostic performance of breast MRI.

References

1. Lehman CD, Gatsonis C, Kuhl CK, et al. MRI evaluation of the contralateral breast in women with recently diagnosed breast cancer. N Engl J Med. 2007;356(13):1295-1303.

2. Proceedings of the European Congress of Radiology. ECR: Vienna, Austria; 2006.

3. Thomas A, Fischer T. An advanced method of ultrasound: realtime elastography—first experience in 300 patients with breast lesions. Poster presented at: 92nd Scientific Assembly and Annual Meeting of the Radiological Society of North America; November 26–December 1, 2006; Chicago, IL.

4. Sarvazyan A, Egorov V, Son JS, Kaufman CS. Cost-effective screening for breast cancer worldwide: current state and future directions. Breast Cancer: Basic and Clinical Research. 2008;1:91-99.

5. Abbate F, Bacigalupo L, Latronico A, et al. Ultrasound-guided vacuum assisted breast biopsy in the assessment of C3 breast lesions by ultrasound-guided fine needle aspiration cytology: results and costs in comparison with surgery. Breast. 2009;18(2):73-77.

6. Fine RE, Schwalke MA, Pellicane JV, Attai DJ. A novel ultrasound-guided electrosurgical loop device for intra-operative excision of breast lesions: an improvement in surgical technique. Am J Surg. 2009;198(2):283-286.

7. Meeuwis C, van de Ven SM, Stapper G, et al. Computer-aided detection (CAD) for breast MRI: evaluation of efficacy at 3.0 T [published online ahead of print September 2, 2009]. Eur Radiol.

8. Siegmann KC, Xydeas T, Sinkus R, Kraemer B, Vogel U, Claussen CD . Diagnostic value of MR elastography in addition to contrast-enhanced MR imaging of the breast—initial clinical results [published online ahead of print September 1, 2009]. Eur Radiol.

ACS Breast MRI Recommendations

The American Cancer Society (ACS) recommends¹ an annual MRI exam for women who have the following indications:

• the BRCA1 or BRCA2 genetic mutations, or a first-degree relative with either;

• a lifetime risk for breast cancer that has been scored at 20 percent or higher;

• receipt of chest radiation between the ages of 10 and 30; and

• Li–Fraumeni syndrome, Cowden syndrome, Bannayan–Riley–Ruvalcaba syndrome, or a first-degree relative with any of these.

The ACS acknowledges that while data are insufficient to make a recommendation either for or against screening with MRI in the following risk subgroups, physicians should make individualized decisions on whether women with the following risk factors receive breast MRI exams:

• a personal history of breast cancer,

• carcinoma in situ,

• atypical hyperplasia, and

• extremely dense breasts on mammography.

Reference

1. American Cancer Society Guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin. 2007;57:75-89.

At the 2008 RSNA meeting, Toshiba America Medical Systems (Tustin, Calif.) introduced two new advances for ultrasound imaging of the breast: MicroPure, an algorithm that aids in the detection of microcalcifications, and the Dynamic Micro Slice transducer for breast imaging, which enhances imaging of superficial structures and helps identify lesions.

“MicroPure is an adapted filter we put onto the image to burn out bright echoes so we can better visualize calcifications,” Erin Owen, Toshiba senior manager for clinical marketing in ultrasound, explains. “Ultrasound has never been really good at looking at microcalcifications. MicroPure puts a color on it to bring out the brighter echoes.”

Owen says the technique aids in the biopsy of microcalcifications, which can be a time-consuming and laborious process. “Calcifications are often cancerous, but there’s no way to tell without a stereotactic biopsy,” she notes. “The procedure can take up to two hours, and it’s not very pleasant. With MicroPure, we can do an ultrasound-guided biopsy and be done in 15 to 20 minutes.”

Carey Weiss, MD, medical director of the Comprehensive Breast Care Center at Mercy Hospital, Chicago, Ill., has been using MicroPure for close to a year. He notes, “We like to use ultrasound for calcifications because it’s so much easier to go after them on an ultrasound than to have the patient lie on her stomach for two hours. When we have a case that we think is a good candidate for biopsy, we’ll use ultrasound.”

In July of this year, Toshiba further enhanced its ultrasound offerings with the introduction of Precision Imaging software for the Aplio^TM XG ultrasound system. The multiresolution signal-processing technology evaluates images line by line, then incorporates information from adjacent lines to enhance the image further.

“Precision Imaging offers a much clearer signal for structure boundaries,” Owen says. “In breast imaging, we look for irregular margins for a lesion, or if it’s a cystic structure, we look to see if it’s truly fluid filled. With Precision Imaging, we can see all the variations within a cyst, which helps to differentiate between cysts and lesions and eliminates false positives for a better, more clear diagnosis.”

Weiss also uses Precision Imaging, which “cleans up the cysts well,” he notes. “With complicated cysts, Precision Imaging helps us be sure of what we’re looking at; it’s another useful tool in ultrasound evaluation of breast lesions.”

Ultrasound imaging of bariatric patients is often hampered by the limits of the modality’s depth penetration. In some cases, larger patients cannot be imaged using the technology because of image-quality issues. Cassie Murvay is an ultrasound product manager for Toshiba America Medical Systems, Inc. in Tustin, Calif. She explains, “Ultrasound penetration depends on the frequency of the signal you’re sending from the transducer. In order to penetrate deeper, you have to go to a lower frequency, but in order to get that, you sacrifice resolution and clarity.”

To solve the frequency problem, Toshiba developed Differential Tissue Harmonic Imaging (D-THI), a proprietary technique designed to better penetrate dense tissue. D-THI, which is available on the company’s Aplio™ XG and Xario™ XG ultrasound systems, sends a single signal consisting of two pulses—one at a low frequency and one at a high frequency.

“The two pulses give the penetration without losing the resolution,” Murvay says, “so on larger, technically difficult patients, we can penetrate all the way through the liver, for example, and still have the resolution necessary for the diagnosis.”

D-THI works by using enhanced effective bandwidth to capture the images. “This technology is ideal for use on any patient who is large or difficult to image,” Murvay notes. “A lot of vascular imaging is done on diabetic patients, and D-THI can help penetrate large, edematous legs to get the vascular images needed. It’s also beneficial in imaging dense livers, kidneys, pancreas—really, any abdominal imaging on bariatric patients can benefit from D-THI.”

Using D-THI is faster than taking multiple images at a lower degree of depth coverage, and it easily accommodates bariatric patients who might otherwise require a different piece of equipment for scanning, improving throughput and saving imaging centers time and money. “It’s a lifesaver for our customers who deal with bariatric patients,” Murvay says.