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Episode-Based Care Payment Approach: Using Advanced Imaging Technologies to Diagnose Acute Stroke More Effectively
June 14, 2011
Over the next several years, healthcare economic policies will change the delivery of medicine. The healthcare sector will migrate from a fragmented, volume-based system to one that is driven by value, accountability, quality and outcomes. As the new episode-based payment programs come into play, it will be incumbent upon stakeholders to demonstrate the clinical utility, operational efficiency and financial performance of new technologies.
Toshiba America Medical Systems, Inc.’s imaging technology offers solutions that will assist healthcare institutions in preparing for episode-based care by effectively utilizing patient-focused imaging technology and a multidisciplinary collaborative approach to treatment.
Episode-Based Care Payment Model
Episode-based care is a payment approach that reimburses providers on expected costs for clinically defined episodes, rather than on a fee-for-service basis. Episode of care provides one fixed payment for the treatment of a specific illness and combines the technical fee with the professional fee. Since this payment approach provides reimbursement on expected costs for clinically defined episodes rather than fee-for-service, healthcare providers must achieve greater efficiencies and better patient outcomes. For example, if a patient has a stroke, everything done to diagnose and treat that condition is bundled together into one clinically defined episode. The goal is to reduce unnecessary services, duplicity of tests and complications – while compensating clinicians for improving the quality of care and reducing costs.
Medicare will launch the episode-based care pilot program no later than January 1, 2013. With such a large segment of patients with this coverage, it will require healthcare organizations to be even more efficient in how they deliver care.
Diagnosing Acute Stroke in an Episode-Based Care Model
Stroke accounts for approximately one in every 18 deaths and is the third most common cause of death in the U.S., according to the American Heart Association. The estimated annual cost of stroke is $50 billion, including healthcare-related costs, disability and lost productivity. When the new episode-based program comes into effect, clinicians will be tasked to diagnose and treat stroke more accurately and quickly to benefit the patient and reduce costs. When evaluating medical conditions to include in this new payment model, Medicare will look at high-cost, high-volume, chronic and acute conditions like stroke, when vetting case types for the pilot program.
In today’s top hospitals and stroke centers, clinicians use the latest CT technology to perform cerebral perfusion imaging to assess neurological disorders, such as stroke, and to make treatment decisions. Depending on the specific case, patients are often taken to interventional labs where the imaging equipment helps guide treatment and supports device placement.
This was not always the case, as limitations in the coverage volume of CT previously prevented perfusion imaging from being a truly effective tool in diagnosing stroke. However, developments in imaging technology, particularly CT, are enabling healthcare professionals to diagnose and treat stroke faster than ever before.
Diagnosing Stroke with Toshiba’s Aquilion ONE
The introduction of Toshiba’s Aquilion TM ONE dynamic volume CT system changed the scope of cerebral perfusion analysis by enabling dynamic imaging of the entire brain and the ability to reduce diagnosis time from hours 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 brain’s dynamic blood flow and real-time function, which is crucial for stroke patients and enables rapid and accurate diagnosis when time is critical.
The Aquilion ONE also features a full suite of dose reduction technologies that limit radiation dose to the lowest possible amounts while maintaining the highest clinically-appropriate image quality needed for diagnosis.
Kaleida Health Stroke Center at Millard Fillmore Gates Circle Hospital and Its Use of Toshiba’s Imaging Technology
Toshiba understands that effectively transitioning to episode-based care requires more than just superior imaging equipment; it requires the cooperation and collaboration of a multidisciplinary team of physicians that appropriately leverage the technology to its fullest capabilities to the benefit of the patient. Toshiba’s technology offers solutions to help healthcare facilities prepare for episode-based care by effectively utilizing patient-focused imaging technology and a multidisciplinary collaborative approach to treatment. Toshiba uniquely offers a multidimensional knowledge base, dynamic customer interaction, and a robust support system of training and education to help medical teams transition and prosper within the new healthcare economic models.
One such example is Toshiba’s partnership with the Kaleida Health Stroke Center at Millard Fillmore Gates Circle Hospital in Buffalo, N.Y. Millard Fillmore Hospital is a 189-bed facility that is part of Kaleida Health, the largest, most comprehensive healthcare system in the region. It is a modern acute care center offering a full range of medical and surgical services, including a world-class neurological and stroke care. The Kaleida Health Stroke Center has integrated Toshiba’s state-of-the-art training and imaging with an outstanding multidisciplinary team of physicians, nurses and technicians, comprehensive education and community outreach. The result has been an improvement in both patient and financial outcomes in the diagnosis of acute stroke that demonstrates a commitment to delivering quality care to the community.
Millard Fillmore’s Results Using 320-Detector Row CT in Diagnosing Acute Stroke
To quantify the results of utilizing the Aquilion ONE in the diagnosis and treatment of acute stroke, Toshiba and Millard Fillmore conducted a retrospective and prospective study on its effectiveness in treating these patients with the new technology. The goal of the non-controlled study was to measure the economic impact that 320-detector row CT has had on the diagnostic workup of patients presenting with symptoms of acute stroke and transient ischemic attack (TIA). Millard Fillmore reviewed the patient diagnostic workup on a retrospective and prospective basis and analyzed all the imaging procedures utilized during the acute inpatient episode of care, focusing on the changes in the diagnostic work-up, inpatient length of stay and discharging disposition since acquiring the Aquilion ONE. Inpatient data sets prior to the Aquilion ONE installation were compared with data sets using the Aquilion ONE, and concerned the top three discharging ICD-9-CM stroke codes.
When Millard Fillmore analyzed the length of stay, discharge disposition and healthcare costs for the top three ICD-9-CM codes for stroke and compared the 2007 and 2009 data sets, the results demonstrated the benefits 320-detector row technology brought to the facility and its patient community. For the three stroke ICD-9-CM codes analyzed, Millard Fillmore found a reduction in hospital stay, had more patients discharged to home and achieved an approximate annualized savings of more than $750,000.
The Kaleida Health Stroke Center at Millard Fillmore is an impressive example of how an exceptional multidisciplinary team with comprehensive education and community outreach can use innovative imaging technology to make a difference in the lives of patients, improve financial performance and result in high quality patient care in today’s uncertain times. Healthcare facilities everywhere can experience the significant cost savings achieved through reduced length of stay, reduction in outpatient services, reduced complications, and lower recurrence of readmission.
The reality is that hospitals that choose not to participate in the national pilot program will be at risk of losing market share because Medicare patients will be encouraged to utilize participating facilities. The healthcare providers which embrace this new, value-based collaborative approach to providing high-quality care can not only retain but even increase market penetration. Toshiba has a proactive approach with the knowledge base, customer support and technology to help healthcare organizations successfully transition and succeed.
ACC Lunch and Learn Sponsored by Toshiba
March 16, 2011
Toshiba is sponsoring a Lunch and Learn event at ACC 2011 on Sunday, April 3 and Monday, April 4. Presentations will begin at 12:30 p.m. and will be held in Toshiba’s booth # 2847.
Dr. Michael Poon, professor of Radiology and Medicine and director, Advanced Cardiovascular Imaging Program, Department of Radiology at SUNY-Stony Brook School of Medicine, and Dr. Chris McClish, board-certified in Cardiovascular Diseases at Shannon West Texas Memorial, will be presenting on “Helping You Prepare for Today’s Healthcare Environment.”
Dr. Poon and Dr. McClish will give presentations on how cardiovascular computed tomography can help in an emergency department and improving outcomes with interventional radial techniques.
Advanced Imaging Technology Aids in Stroke Diagnosis and Treatment
May 10, 2010
According to the American Heart Association, stroke is the leading cause of serious, long-term disability in the U.S., and it ranks third in causes of death. It is often said that “time is brain,” since the faster the clinician can detect areas of decreased blood flow and determine the optimal treatment plan, the better the patient’s chances for survival and recovery. Toshiba has a host of technologies that help medical professionals better diagnose and treat patients presenting with stroke symptoms.
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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Aquilion ONE’s SVD+ Helps to More Accurately Diagnose Stroke
Toshiba’s Aquilion® ONE dynamic volume CT system has changed the scope of brain perfusion analysis by enabling dynamic imaging of the entire brain and dramatically improving the ways physicians diagnose and treat stroke. One feature, available only on the Aquilion ONE, due to its ability to image the entire brain in one rotation, is the Singular Value Decomposition Plus (SVD+) perfusion algorithm. The SVD+ algorithm produces advanced CT perfusion imaging that is unmatched in the industry.
“The Aquilion ONE dynamic volume CT system with the SVD+ perfusion algorithm is emerging as a new standard of care for brain perfusion analysis,” said Erin Angel, PhD, manager, CT Clinical Science, Toshiba. “The fast exam time, high image quality and lower radiation doses of the Aquilion ONE, combined with the more accurate perfusion analysis produced by SVD+, are changing the ways physicians identify and treat stroke quickly.”
Toshiba’s SVD+ Perfusion Algorithm
Brain perfusion imaging in CT is used to determine if the patient has had a stroke and to distinguish which areas of the brain are beyond repair and which areas of the brain may be saved through intervention. Perfusion analysis can help clinicians estimate treatment response and develop therapeutic pathways designed specifically for individual patients. The advanced SVD+ algorithm was developed for the Aquilion ONE to improve the quantitative maps produced by perfusion imaging and to give physicians more accurate data for the evaluation of stroke.
Standard SVD algorithms can sometimes produce perfusion maps that are not completely accurate, since they have difficulty calculating certain delays in blood flow. These blood flow delays, if not identified appropriately, produce perfusion maps that provide unclear results to the physician. Toshiba’s SVD+ is an advanced perfusion algorithm that eliminates these issues. SVD+ is a delay-insensitive SVD algorithm that uses an innovative technique to account for delays in blood flow and perform calculations with faster computation times. The SVD+ algorithm is unique in that it always begins prior to the contrast’s arrival to more accurately quantify the region of the brain being imaged.
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Aquilion ONE Enables Physicians to Prevent Stroke
Pamela Louderback, a grandmother from Taylor Mill, Ky., had been experiencing dizzy spells for months. Although she attributed the episodes to a previous condition, physicians could not accurately diagnose her. Pamela had suffered complications from a surgery, and her left carotid artery had to be completely closed. Pamela suspected that her dizziness was caused by blockages in her right carotid artery, but doctors were unable to confirm her belief.
She went about her daily routine, until one day, after blacking out at work, Pamela found herself at St. Elizabeth Healthcare’s emergency room (ER). Unbeknownst to her and her doctors, she was on the verge of suffering a stroke.
According to Dr. Jeff Dardinger, director of Imaging, Vascular Institute, St. Elizabeth Healthcare, a typical patient presenting with these symptoms would have to undergo a battery of tests and be admitted to the hospital before a diagnosis could be made. For example, a patient would likely have had a CT exam of the head and neck and been admitted to the hospital while an MRA exam was scheduled. After a consultation the next day, the patient would have the MRA. According to Dr. Dardinger, this process could take anywhere from two to four days. For anyone who has had a stroke or knows someone who has, you know this timetable can prove fatal or debilitating.
Fortunately for Pamela, she was taken to St. Elizabeth – the first hospital in Kentucky to purchase an Aquilion® ONE. Because of the Aquilion ONE’s ability to capture the entire brain in one rotation, as well as its ability to show function over time, physicians diagnosed Pamela within an hour and prevented a stroke from occurring at all. This system is ideally suited for detecting neurovascular conditions quickly. It uses 320 ultra-high-resolution detector rows to capture up to 16 cm of coverage, enough to image the entire brain or heart and show organ movement.
Images confirmed that Pamela’s right carotid artery was 90 percent occluded, which significantly reduced blood flow to the brain. By diagnosing this condition within the hour, physicians immediately planned stent treatment to open the artery passage, preventing a stroke.
“Toshiba’s Aquilion ONE allowed us to accurately diagnose the patient quickly, dramatically improving her quality of life,” explained Dr. Dardinger, who interpreted Louderback’s images. “Without dynamic volume CT, the patient would have undergone a series of tests for two to four days, at a minimum, to uncover the occlusion. Being able to diagnose the patient within an hour allowed us to plan treatment immediately and prevent a stroke from occurring.”
“I truly believe this system saved my life,” explained Louderback. “I had several exams over the past few months, none of which could detect why I was having dizzy spells. It wasn’t until I was imaged in the ER, using the Aquilion ONE, that a definitive answer could be found.”
Introduced in November 2007, dynamic volume CT scans an entire organ in a single pass and produces 4D videos that show an organ’s structure, its movement and its blood flow. In comparison, a 64-slice, 128-slice or 256-slice CT scan can capture only a portion of an organ in a single pass, requiring physicians to “stitch together” multiple scans of an organ to get a full image. The new technology helps reduce multiple exposures to radiation and exam time.
Designed for today’s healthcare environment, the Aquilion ONE reduces overall healthcare costs and streamlines diagnosis by replacing several tests with a single, comprehensive exam. The Aquilion ONE’s single exam helps reduce unnecessary testing, as well as the accompanying accumulative radiation and contrast dose.
“The Aquilion ONE can dramatically improve patient care by providing a fast, comprehensive exam for patients suffering from life-threatening conditions, like stroke and heart attack, while helping to lower healthcare costs,” explained Robb Young, acting director, CT Business Unit, Toshiba. “St. Elizabeth Healthcare is an excellent example of where the Aquilion ONE enabled physicians to diagnose and treat a patient before a serious stroke occurred.”
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Clinical Case of the Month: Acute Stroke
A stroke occurs when a blood clot clogs an artery or a blood vessel ruptures and interrupts normal blood flow to the brain. When a person suffers a stroke, their brain cells may begin to die and brain damage can occur, affecting normal brain activity that controls speech, movement, and memory. Stroke sufferers often experience sudden trouble speaking or understanding, sudden numbness in the face, arm or leg, sudden dizziness with trouble walking or balancing, and/or sudden severe headache.
According to the American Heart Association, stroke is the third leading cause of death, ranked behind heart disease and cancer. In 2006, over 137,000 people died as a result of stroke, and studies show that approximately 795,000 people suffer a new or recurrent stroke each year (~75% first attacks and ~25% recurrent)1
Computed Tomography (CT) scans are commonly used to diagnose stroke because they easily detect bleeding inside the brain and can be performed quickly to prevent further brain damage. Toshiba’s Aquilion ONE® 320-detector row dynamic volume CT scanner has the ability to reduce diagnosis time from hours or days to minutes by imaging an entire organ, such as the brain, in one rotation and show dynamic blood flow in real-time, critical for stroke patients.
Case Study: CT DSA, Brain Perfusion, and 3D TTP maps using dynamic volume CT was used to diagnose this acute stroke.
Technology: Toshiba Aquilion ONE 320-detector row dynamic volume CT.
Patient History: A 76-year-old woman was having dinner when she noticed difficulty finding words and with her speech. She called her internist, who advised her to take 325 mg of aspirin and go to the emergency room (ER). By the time she reached the ER, her symptoms had resolved. She was admitted for further evaluation and management. The acute stroke imaging protocol on the Aquilion ONE CT system was requested as a matter of priority. All diagnostic information was provided to the physician in 4.5 minutes.
Image Gallery
The CT DSA images clearly demonstrate near-complete occlusion in the inferior division of the left MCA at the M2 level, with collateral flow and reconstitution of some MCA branches distally. These images were generated automatically with perfect bone subtraction.
Abnormal perfusion is demonstrated in the left posterior temporal and parietal regions, characterized by increases in TTP and MTT, with a decrease in CBF. The CBV within this lesion is increased, indicating good autoregulation.
The fused 3D TTP maps are excellent for showing the anatomical relationships of the occluded MCA branch and the resultant perfusion deficit.
Images courtesy of Millard Filmore Gates Circle Hospital
Reference:
1. “Stroke Statistics.” American Heart Association. 29 April 2010. http://www.americanheart.org/presenter.jhtml?identifier=4725
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Toshiba Clinical Trials Advance CT and Ultrasound
April 1, 2010
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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Webinars Focus on High-tech Imaging Applications Education
March 1, 2010
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.”
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ACC Preview: Advances in Cardiac Imaging
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.
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Beyond Comfort: The Importance of Patient-friendly Features
December 7, 2009
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 TitanTM 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 PianissimoTM 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.