Ultrasound




Siemens introduces new Automated Breast Volume Scanner

A range of new ultrasound devices were shown off at the Arab Health expo in Dubai in January. Middle East Health looks at new products from Philips, Siemens and GE. We also take a brief look at a cutting-edge pocket ultrasound device developed by a student at Weill Cornell in New York.

Siemens showed off their new automated breast volume scanner (ABVS), an application that works with the Acuson S2000 ultrasound system.

Siemens says the ABVS is the world’s first multi-use, automated breast volume ultrasound system offering new diagnostic information and intelligent knowledge-based workflow solutions.

“The application enables clinicians to reduce scan time from around 30 minutes to around 10 minutes. So you can increase your throughput,” Mohamed Niyaz, Regional Business Manager, Siemens Ultrasound, Middle East and West Asia, told Middle East Health.

“It also acquires 300-400 frames in that scanning time which gives doctors a range of different views of the breast. This is particularly good for diagnosis in dense breast tissue.”

According to research published in the New England Journal of Medicine, dense breast tissue increases a woman’s risk of breast cancer up to five-fold. While mammography remains the method of choice for breast cancer screening, a study published by the RSNA in 2002 found that the detection rate for nonpalpable, invasive breast cancers increased by 42% when mammography was followed by an ultrasound examination.

Klaus Hambuechen, CEO, Ultrasound, Siemens Healthcare, pointed out he was “convinced that ABVS could make a significant contribution in diagnostic confidence for women with dense breast tissue and inconclusive mammograms”.

The Acuson S2000 ABVS system automatically and quickly acquires full-field sonographic volumes for comprehensive review and diagnosis of the breast, streamlining workflow and reducing operator dependence and variability. The system also features the intuitive, anatomical coronal plane, not available using conventional ultrasound. This view provides a more understandable representation of the global anatomy and architecture of the breast. Semi-automated reporting and comprehensive BI-RADS (Breast Imaging-Reporting and Data System developed by radiologists for reporting mammogram results using a common language) reporting capabilities further enhance the clinical workflow.

The ultrasound system has an innovative, mobile in-suite design combining the advanced Acuson S2000 with a transducer specifically designed for automated ultrasound breast volume imaging. To further optimise highvolume patient care, the system also supports innovative breast imaging applications, such as fatty tissue and Siemens’ ‘eSie Touch’ elasticity imaging.

Siemens says the knowledge-based workflow automates and streamlines a broad range of routine clinical tasks. Using learned pattern recognition from an expert database of thousands of clinical cases, knowledge-based workflow applications recognise anatomical patterns and landmarks and can automatically perform measurements and other routine tasks to achieve a new level of accuracy and efficiency.

Niyaz said the ABVS will be commercially available in the Middle East from March-April. He pointed out that although it is a second generation application the previous version could not be upgraded to this version as it is it uses a different, more advanced imaging platform.


Philips launches price-sensitive HD9




Philips Healthcare launched globally their new HD9 ultrasound system at the Arab Health expo in Dubai in January.

Speaking to Middle East Health Janice Blackwell, vice president, ultrasound marketing, Philips Healthcare, explained that over the past few years Philips has focused on updating their family of ultrasound products.

“We have the premium IU22 and IU23 ultrasound family. We also have the HD (High Definition) family. These systems are geared towards people who want more throughput – those who want high performance, but may need a wide variety of applications,” Blackwell said.

“Last year we introduced two new products to this family – the HD15 and the HD7. But we still had a gap for a product at a much lower price point, but still delivering very high quality images. We have filled this gap with the HD9.”

The HD9 is geared towards foetal imaging and breast imaging – that is women’s health – although it is also robust enough and has all the capabilities for general day-today imaging. As well as women’s health, the HD9 is also able to cater for applications including general imaging, adult and paediatric cardiology, general paediatric and urology.

“Philips has a care cycle approach to women’s health, so we wanted to support that initiative. And the feedback we have been getting from this field is excellent,” said Blackwell.

“Many of the transducers from the premium platforms have been added to the HD9 so that you get a very high level of performance.

“We have spent a lot of time developing the application so that the user can do a lot of fine tuning with these transducers. The system can be optimised for specific applications so that clinicians can get the results they need much quicker. That’s one of the things we have heard from customers looking at the product at Arab Health.”

The HD9 will be available for shipping in the Middle East from March this year.

The HD9’s key features

• Versatile and easy-to-use 3D/4D capability
• Philips Live iSlice, which enables clinicians to focus on specific areas of interest within a volume and find images with the best views and content, making for more confident diagnoses
• Trimester-optimised Spatio-Temporal Image Correlation (STIC) to evaluate foetal heart anatomy and function by allowing clinicians to create a volume image that can be displayed and interrogated during playback
• Tissue Specific Imaging technology additionally allows the system to be optimised for a specific patient or examination type, to provide excellent imaging quality with little need for optimisation
• Tissue aberration correction which offers speed of sound compensation for clear and accurate data even in difficult to image patients
• iSCAN image optimization, a quick, onebutton function that automatically adjusts multiple parameters in 2D and Doppler exams
• Quad View, a tool that allows you to review four structures, in multiple modes, simultaneously on a single screen
• Quick Keys for foetal biometry, which facilitates workflow during patient exams
• Menu optimisation, so that the items you use most often are never more than one layer deep
• A full suite of DICOM capabilities to facilitate patient workflow and information exchange
• High Q automatic Doppler analysis
 




GE’s Logic E9 fuses images with CT and MR

GE Healthcare showed off its latest ultrasound systems at the Arab Health expo in Dubai in January.

Talking about GE’s new ultrasound technologies, Hisham Youssef, General Manager Ultrasound, Middle East, Africa & Turkey for GE Healthcare said: “We worked closely with a global team of radiologists and sonographers to develop our new ultrasound architecture, giving clinicians the advantages of imaging modalities – MR, CT and PET.”

This new GE architecture, called Agile Ultrasound, replaces old assumptions of conventional ultrasound systems with new, modular mathematical models that provide more accurate measurements of how sound interacts with different body tissue types. The result of the LOGIQ E9 architecture is an improved, more life-like image without a lot of manual adjustments to view specific anatomy.

Two key systems on show were the LOGIQ E9 – for radiology and vascular applications that fuses ultrasound images with images from other imaging modalities like CT and MR; and the the LOGIQ e Breakthrough 2009, which combines real-time clinical images and control capabilities on the same touchscreen user interface.

Logiq E9

The new LOGIQ E9 includes Volume Navigation, an innovative tool which incorporates two key components to maximise the system’s new agile ultrasound architecture: ‘Fusion’ to combine the advantages of realtime ultrasound imaging with the high spatial and contrast resolution of CT, MR or PET and a ‘GPSlike technology’ to track and mark a patient’s anatomy during the ultrasound exam.

Another key feature for the LOGIQ E9 is Scan Assistant, which aids clinicians to put the emphasis on diagnosis rather than on keystrokes. This tool allows a clinician to preprogram the actions most often performed, and then let the system do the detailed manipulations as the patient is scanned. It improves exam time up to 54%, automatically inserts comments, completes measurements, steers Color Doppler, sets up imaging controls and modes, and improves ergonomics.

Logiq e Breakthrough 2009

LOGIQ e Breakthrough 2009 is an exclusive ultrasound technology that simplifies the use of ultrasound and optimisation of images and helps clinicians focus less on controls and keyboards, and more on patients and their images. It streamlines the ultrasound interface onto one screen – a flat touch screen – for both viewing images and running the controls, which decreases the learning curve on the system and makes training easier.

Voluson E8

GE Healthcare also exhibited the Voluson E8 with its improved probe imaging capabilities. New automation software has been migrated across the women’s healthcare ultrasound systems including SonoVCADheart, GE’s proprietary technology that streamlines the acquisition of volumetric images of the foetal heart, and SonoAVCfollicle, which calculates the number and volume of ovarian follicles.





Pocket-sized ultrasound device could help treat cancer, relieve arthritis

A prototype of a therapeutic ultrasound device, developed by a Weill Cornell Medical College, New York, graduate student, fits in the palm of a hand, is battery-powered and packs enough punch to stabilise a gunshot wound or deliver drugs to brain cancer patients. It is wired to a ceramic probe, called a transducer, and it creates sound waves so strong they instantly cause water to bubble, spray and turn into steam.

Tinkering in his Olin Hall lab, George K. Lewis, a thirdyear Ph.D. student in biomedical engineering and a National Science Foundation fellow, creates ultrasound devices that are smaller, more powerful and many times less expensive than today’s models. Devices today can weigh 15 kilograms and cost US$20,000; his is pocket-sized and built with $100. He envisions a world where therapeutic ultrasound machines are found in every hospital and medical research lab.

“New research and applications are going to spin out, now that these systems will be so cheap, affordable and portable in nature,” Lewis said.

The development of one of his portable devices is detailed in the journal Review of Scientific Instruments, published online 11 November 2008.

Ultrasound is commonly used as a nondestructive imaging technique in medical settings. Sound waves, inaudible to humans, can generate images through soft tissue, allowing, for instance, a pregnant woman to view images of her baby. But the higher-energy ultrasound that Lewis works with can treat such conditions as prostate tumours or kidney stones by breaking them up. His devices also can relieve arthritis pressure and even help treat brain cancer by pushing drugs quickly through the brain following surgery.

Lewis suggests that his technology could lead to such innovations as cell phone-size devices that military medics could carry to cauterise bleeding wounds, or dental machines to enable the body to instantly absorb locally injected anaesthetic.

Lewis miniaturised the ultrasound device by increasing its efficiency. Traditional devices apply 500-volt signals across a transducer to convert the voltage to sound waves, but in the process, about half the energy is lost. In the laboratory, Lewis has devised a way to transfer 95% of the source energy to the transducer.

His new devices are currently being tested in a clinical setting at Weill Cornell Medical College. Under the direction of Jason Spector, MD, director of Weill Cornell’s Laboratory for Bioregenerative Medicine and Surgery and assistant professor of plastic surgery, Peter Henderson, MD, the lab’s chief research fellow, is using one of the devices in experiments that aim to minimise injury that occurs when tissues do not receive adequate blood flow.

Their lab is performing tests in animals to determine whether low doses of the chemical hydrogen sulfide, known to be toxic at high doses, might be able to minimise such injury by slowing cellular metabolism.

Doctors are hopeful that the ultrasound from Lewis’ portable device will enable hydrogen sulfide to be targeted to specific parts of the body, allowing doctors to use less of it, and cutting down on toxicity risks, Henderson explained.

The medical doors that Lewis’ device may one day open are groundbreaking, Henderson said.

“People are realising that when harnessed appropriately, you can use ultrasound to treat things as opposed to just diagnose them,” Henderson said. “It’s a wide-open field right now, and George’s device is going to play a huge role in catalysing the discovery of new and better therapeutic applications.”



Could point-of-care ultrasound replace the stethoscope?



Point-of-care ultrasound is now a powerful front-line medical tool, with potential benefits in a wide range of clinical applications ranging from anaesthesia to palliative care. Recent advances in the technology have made these highly portable ultrasound instruments, such as SonoSite’s M-Turbo system, a genuine alternative to stationary or cart-based equipment for a majority of standard diagnostic investigations and clinical procedures.

Anaesthesia is one discipline to have embraced this new technology, with ultrasound needle guidance now routine. Since this technique was first pioneered for needle-guidance and line placement applications, ultrasound usage has spread rapidly through the anaesthesia community, offering easier and safer positioning of nerve blocks and intravenous lines. Ultrasound is now the method of choice for many anaesthetists, and has the potential to completely replace nerve stimulators and landmark- based techniques in the future. This change in general practice has no doubt been aided by the robustness and ease-of-use of instruments such as SonoSite’s MicroMaxx system.

Durability and user-friendliness have become cornerstones of successful hospital equipment, and manufacturers of hand-carried ultrasound instruments need to ensure the equipment they provide is reliable, especially when lives are at stake. This is particularly true in emergency medicine, where point-of-care ultrasound has found roles in placement of lines or drains and focused abdominal sonography for trauma (FAST) scanning. In this setting, rapid bedside ultrasound provides clinical information not available by physical examination alone, offering better insight into the condition of trauma patients and allowing immediate, potentially life saving, action to be taken without delay. Although many hand-carried instruments are suitable for use in emergency medicine, focused systems – such as SonoSite’s S-FAST tool – provide specially tailored features designed for just a single discipline. By removing unnecessary or unwanted features, these systems put the required functions at the user’s fingertips with the press of just a few buttons and the MTurbo, S Series and MicroMaxx systems come with SonoSite’s industry-leading 5- year warranty. As the capabilities of hand-carried ultrasound instruments expand to incorporate ever more advanced features, it is likely that the use of these dedicated systems will become commonplace in many specialties.

Within a hospital setting, the widespread deployment of hand-carried ultrasound systems offers benefits to both patients and staff by reducing interdepartmental transfer of patients, cutting radiology department waiting time and allowing sonographers to concentrate on in depth diagnoses and specialist scanning applications requiring their expertise. Close collaboration with radiology departments offers the potential for clinicians to provide complimentary sonography services, providing limited point-of-care ultrasound within a defined framework, and only referring patients requiring specialist investigation. This strategy has been well received by the majority of practitioners and, thanks to the high image quality and advanced imaging capabilities of systems such as the M-Turbo, also offers sonographers the option of coming to the patient for all but the most difficult and complex diagnoses.

In addition to improving existing care, the accessibility of hand-carried ultrasound systems has led to new therapies such as endovenous laser ablation (EVLA), a minimally- invasive treatment of varicose veins. The relatively rapid development of these novel ultrasound-based treatments suggests that point-ofcare ultrasound is likely to become far more extensively used in the future, with innovative uses of ultrasound now being explored in a wide variety of disciplines including emergency medicine, critical care, obstetrics and gynaecology, anaesthesia, palliative care and orthopaedics. Ultimately, point-of-care ultrasound offers healthcare professionals in most fields greater insight into patient pathology, allowing them to provide faster, more appropriate care. This potential has raised the question of when and where training in sonography techniques should be given, and many clinicians are now calling for basic ultrasound to become a mandatory element of medical training, even at the earliest stages of tuition.  

 Date of upload: 31st March 2009

                                  
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