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New Technologies and Applications Enhance Breast Ultrasound

October 1, 2009

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.”

Titan MRI at SDMI: An Imager for Breast & Body

When Steinberg Diagnostic Medical Imaging (SDMI), Las Vegas, Nev., installed the Vantage Titan™ MRI system from Toshiba America Medical Systems (Tustin, Calif.) a few months ago, founder Mark Winkler, MD, was particularly looking forward to adding high-resolution breast MRI to SDMI’s capabilities. The addition of Toshiba’s Radiance Plus breast-imaging coil, available on both Vantage Atlas and Vantage Titan systems, meant SDMI could perform high-resolution breast imaging without needing a dedicated breast MRI unit.

SDMI selected the Vantage Titan MRI, a 1.5T system, because, in Winkler’s words, “It’s short, wide, and quiet.” The system features a 71-cm patient aperture and a field of view of 55 by 55 by 50 cm; it also includes Toshiba’s patented Pianissimo^TM technology, which helps to limit MRI acoustic noise. Winkler says the Vantage Titan is “more open than what is considered a conventional open system.”

The wide bore enables the Titan system to accommodate more patients while leaving ample space for the Radiance coil. “It helps make the experience nicer because it’s wider, it’s more open, and we can physically accommodate larger patients,” Winkler says. “The very short and wide bore (as well as the quietness of the system) makes it very patient friendly.”

The versatility and high image quality of the Vantage Titan have inspired SDMI to install the system in multiple facilities. “We are getting a new Titan next month and upgrading two systems to Titans, so we’ll have four within six months,” he says. “At that point, most of our breast MRI will be done on a Titan. It’s equivalent to a dedicated breast MRI, but it’s also a great open whole-body system.”

Toshiba Grants Bolster Creative Safety Initiatives

September 1, 2009

When St. Mary’s Regional Medical Center, Lewiston, Maine, decided to renew its focus on CT quality and safety, the first step was developing a set of best practices upon which future improvements to CT workflow could be based. “We thought we could tap into the validated knowledge that resource centers had put together and actually implement those findings in the field,” explains Donna Knightly, RT, radiology supervisor. “Our objectives were dual: promoting the use of ACR appropriateness criteria and improving patient safety in any way that we could.”

In January 2009, AHRA: The Association for Medical Imaging Management, in conjunction with Toshiba, awarded three $7,500 grants to help fund innovative patient-safety and quality initiatives. St. Mary’s was a recipient, along with Washington Hospital Center, Washington, DC, and Jennie Edmundson Hospital, Council Bluffs, Iowa. “We have changed the way we engage patients. We now are more focused on being patient-centered and family-centered,” Knightly says. “It’s little things that make a big difference, like having a blanket warmer in the room. We just converted a warmer box that was used for contrast media, and we located this right in the scanner room so it’s easy to access for the technologist and they can keep the patient warm during the scan.”

Gayle Thompson-Smiley, director of Radiology at Washington Hospital Center, used her facility’s grant to initiate a patient-handoff program designed to refine the processes involved in transferring 300-350 patients a day from the hospital floor to the radiology department. “Washington Hospital Center is a very large institution and quite complex. In this type of environment, we’re also focused on how we can better improve the patient experience and the patient outcome,” she says. “This was a very unique opportunity for us.”

Meanwhile, Jim Lipcamon, director of Imaging Services at Jennie Edmundson Hospital, sought to leverage his hospital’s information systems to alert radiologic technologists to potential complications associated with contrast media for imaging. “People who take metformin [for type II diabetes] are contraindicated to receive iodinated contrast,” he explains. “We wanted to hardwire that process. Prior to the grant, that process was strictly on paper, relying on the patients to remember to tell their physician or tell the nurse on the floor. With the increase in obesity nationwide, we felt that this was a critical issue that needed to be addressed in our institution.”

Tom Kaiser, informatics pharmacist at Jennie Edmundson, is grateful for the interdepartmental collaboration fostered by the grant. “We’ve been able to use a multidisciplinary approach to our patient-safety enhancements,” he says. “It allowed me an opportunity to work with IT professionals, radiology professionals, and the pharmacy itself to come up with a program that generated rules based on patients’ medications.”

Washington Hospital Center is developing a CME course to train staff on successful handoff communications programs. “The CME event will help prepare physicians in our staff to really think about how best to keep patients safe in day-to-day care and in whatever handoff communication processes that they are involved with,” says Kathleen Srsic-Stroehr, senior nursing director for Evidence-based Practice and Quality. “It’s really important to think about those particular processes and those sender and receiver communication messages that are so important in a handoff communication situation.”

Knightly concurs: “This is a great opportunity for other departments in CT to tap into this knowledge and apply it to what they do every day out in the field. These best practices are very simple, very usable and make a difference in patient care and patient safety. It’s very exciting to be able to share what we’ve found and also to encourage people to use what’s out there.”

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Leveraging Image Maker for Innovative Marketing

August 1, 2009

When Harrisburg, Pa-based PinnacleHealth System acquired an Aquilion® ONE CT scanner from Toshiba, Lisa Henry, director of marketing, was eager to promote the new technology. “We were one of a handful of facilities in the country to install that technology first,” she recalls. Henry began by marketing to referring physicians prior to implementation. “We reached out to our referrers first because they don’t like their patients to come in talking about something they aren’t aware of,” she says.

Pinnacle invited its community of referring clinicians to a presentation highlighting the Aquilion ONE’s features and capabilities; from the start, Henry knew the invitation had to be as unique as the technology itself. “We wanted the invitation to be catchy and to attract attention in a busy office,” she says. “The best way for referrers to understand the difference between the Aquilion ONE and a 64-detector row CT was to see the 3D images in color.” Because Pinnacle had yet to install the scanner, Henry’s team pulled clinical images from the Image Maker kit provided by Toshiba and loaded them onto cartridges for custom-made slide viewers based on the View-Master® model. “We mailed the slide viewers in a clear plastic tube so they would be noticed immediately,” Henry says. “It was a huge success. We had a great turnout at our open house.”

Becky Daghir Wardzala, public relations manager for Hendricks Regional Health, Danville, Ind., also felt that referring-physician outreach was crucial to marketing Hendricks’ new Vantage Titan™ MRI system. “When we get something new that’s better for patients, we like to give physicians some clinical information so they can understand the benefits,” she says. Hendricks conveyed this information using a letter from its radiology director, combined with print materials based on Image Maker templates.

“We inserted a customized photo of our machine, and we dropped in a paragraph about how we’re looking for the best-quality images for proper diagnosis,” Wardzala recalls, “There was already a nice list of bulleted points outlining the benefits for physicians and patients in the Image Maker materials, so we included that as well. The letter from our radiology director recapped those benefits.”

Anne Kolwe, marketing director for Cardiovascular Institute of the South (CIS), Houma, La, focused more on patient marketing following the institute’s acquisition of an Aquilion ONE CT system. “The referring physicians already knew what the technology was, but to reach our patients, we needed to use a lot of different media outlets, including newspapers and television,” she says. “We wanted to humanize the campaign and give patients a better understanding of how the technology relates to them.”

Though CIS developed its own print materials and television spots in accordance with its established branding, Kolwe used the camera-ready images provided by the Image Maker kit in the campaign. “The scanner is an example of how we offer the latest and greatest technology,” she notes, “so the commercials featured high-tech images. We wanted to give the feel that we are using the most advanced technology.”

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Diabetic Patients Benefit from Non-contrast MRI

June 1, 2009

During the past two decades, there has been a dramatic increase in obesity among U.S. residents, according to the Centers for Disease Control and Prevention; in 30 states, more than a quarter of the population is obese (see figure above). The rise in obesity has led, in turn, to an increase in the incidence of diabetes, presenting the radiology community with a fresh challenge: How can radiologists accurately and safely image patients with comorbidities ranging from slow blood flow to kidney disease?

“Vascular disease is obviously a huge problem in the diabetic population and is a major cause of morbidity and mortality, with limb loss and gangrene,” according to Timothy Albert, MD, medical director of the Cardiovascular Diagnostic Center of Salinas Valley Memorial Healthcare System, Monterey, Calif. “At a minimum, it prevents patients from being active, so one of the things we try to emphasize in our community is the importance of aggressively working up this disease. If you can diagnose it, you can treat some patients with cholesterol medications, blood-pressure medications, and so on. For those who have a blockage, you can fix it.”

In 2008, Salinas Valley installed a Vantage™ Atlas MRI system from Toshiba America Medical Systems, Inc. in Tustin, Calif., and began using the scanner’s non-contrast protocol to image more than 90 percent of its patients. “We prefer to image these patients without contrast for a couple of reasons,” Albert notes. “A lot of times, these diabetic patients have some early kidney disease (if not advanced kidney disease), and you’ve got issues with veins not getting enough contrast, especially in the lower extremities.”

The 1.5T Atlas uses Toshiba’s proprietary contrast-free imaging techniques. “In terms of image quality in the renal area, I’d say it’s one-to-one with contrast-enhanced MRI. It’s as good, if not even better; there’s often some improvement, in that you can actually see the branching vessels better than when you’re using contrast, which can wash the image out,” Albert says.

Using non-contrast MRI, however, eliminates other timing issues, such as the need to take the scan while the contrast is flowing through the vessels at an optimal level. “Up to 5 percent of the time, even with an experienced technologist, you can miss it,” he says, “and you’ll still have problems with the veins getting enough contrast.”

Use of the non-contrast technique improves workflow and throughput, Albert says, by eliminating the obstacles that come in tandem with using gadolinium or other contrast agents. “With contrast-enhanced imaging, there’s always a certain percentage of patients whose exams you may need to redo,” he notes. “IV issues themselves—plus the risk of reactions or complications from the IV (although low)—also contribute to the amount of time it can take to scan one patient.”

There are throughput benefits specific to imaging the bariatric/diabetic population, he adds. “With diabetic patients, it can be hard to find a vein, and sometimes you can’t get an IV the size you need for a rapid injection. You can spend 20 minutes looking for the right size IV,” Albert says. “For patients with kidney disease, logistically, it’s nice not to have to make sure you’ve got their latest kidney-function tests, because that can slow the process of getting patients through, and for patients who do have a contraindication for gadolinium, we’re not dusting off the books and trying something new. This is what we do routinely.”

Non-contrast MRI also saves money—well over $100 per study, according to Albert. “We’re in a day and age when reimbursement is getting cut and cut, and this is a big way to save,” he says. “It’s not only the contrast bill, which could be up to $100 for the average study. You’ve also got IV supplies, and nursing time to put in the IV. We’re working on some financial models to compare the two, but you’re probably looking at saving up to $150 per study.”

Albert emphasizes that while the non-contrast technique is particularly beneficial in imaging the diabetic population, it can be used on any patient. “There are a lot of misconceptions out there regarding who is the ideal patient for this,” he says. “We’ve done a cross-section of patients of every size in the past year, and we’ve had very good results. This really is a robust technique.”

D-THI Deepens Ultrasound’s View

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.

Ultrasound Helps Identify Rare Pediatric Tumor

January 1, 2009

Cincinnati Children’s Hospital uses ultrasound to aid in the diagnosis of a Sertoli-Leydig cell tumor in a nine year old female patient who presented with vomiting and abdominal pain. Click here to read the case study.

Clinical Experiences Shared by World-Renowned Physicians at 2008 RSNA

December 1, 2008

Although professional attendance was down slightly, the science was strong at the Radiological Society of North America’s (RSNA) Scientific Assembly and Annual Meeting. Physicians from around the world continue to gather in Chicago to share their clinical experiences with each other. At the 94th meeting held earlier this month, Toshiba worked with innovative physicians to ensure that collaboration extended beyond the session hours by holding evening events where leading physicians were able to present their validation of imaging technology.

This year Toshiba’s Ultrasound (UL) and Magnetic Resonance (MR) modalities introduced new techniques and equipment dedicated to improving women’s imaging. In conjunction, Toshiba sponsored an evening event where physicians shared how Toshiba’s technology is helping women.

Pamela M. Otto, M.D., professor and director of Breast Imaging & Intervention, Department of Radiology, UT Health Science Center & University Health System, San Antonio discussed her experiences with Toshiba’s newRadiance Plus Breast Imaging Coil, which optimizes Magnetic Resonance Mammography (MRM) on the Toshiba Vantage systems. In fact, this coil enabled Dr. Otto to conduct the first contrast-free breast MRA exams. Toshiba is a pioneer in contrast-free MRA techniques, and now plans to develop a sequence that will enable contrast-free breast MR exams.

Ellen B. Mendelson, M.D., F.A.C.R., Northwestern University and Thomas Fischer, M.D., Charite Hospital, University of Berlin presented their experiences with Toshiba’s ultrasound technology. Both discussedToshiba’s new and exclusive ultrasound technique — MicroPure™, which helps physicians detect breast lesions and micro-calcifications more clearly, as well the sonoelastography suite, ElastoQ (works-in-progress), a non-invasive medical imaging technique that evaluates tumors based on their stiffness (elasticity) compared to normal tissue. Both of these Toshiba collaborators presented cases that provided insight on ultrasound’s future as an effective tool for diagnosing breast disease.

At a CT event the same evening, Frank J. Rybicki, M.D., Ph.D., director, Cardiac CT & Vascular CT/MRI, Brigham and Women’s Hospital and William W. Orrison, M.D., MBA chief of neuroradiology, Nevada Imaging Centers shared their experiences with the Aquilion® ONE 320 detector row CT.

Dr. Rybicki provided insights into key research that has been completed on the Aquilion ONE over the last year. For the first time, CT can now visualize how the cardiac vessels curve and measure flow dynamically within the vessels. He also discussed Brigham and Women’s work on the recently announced CORE 320 worldwide multicenter trial that will compare dynamic volume CT to SPECT for evaluating myocardial perfusion.

Dr. Orrison has completed more than 3,500 patient studies on the Aquilion ONE and shared the way this technology is changing his practice. Not only did Dr. Orrison showcase his whole brain perfusion studies, but he also showed advanced dynamic motion studies of musculoskeletal anatomy, which were clinically used for surgery planning and follow up.