Ultrasound




Product showcase


 

Developments in ultrasound by the leading ultrasound device manufacturers appear to be aimed at increasing portability of the devices while trying to keep the key strengths of the more robust systems. Where the more robust systems are concerned improvements are largely in the addition of new imaging capabilities, such as image fusion, and the development of new transducers. Middle East Health looks at a selection of ultrasound systems that have been recently showcased in the Middle East: Siemens Healthcare’s premium Acuson S3000; GE Healthcare’s Logiq S8; Medison’s (now Samsung) Accuvix A30; and Philips Healthcare’s Sparq.

Siemens Healthcare’s Acuson S3000

Siemens Healthcare unveiled its new Acuson S3000 at RSNA in the Chicago in November last year. The system was also on show at Arab Health in Dubai in January. The company is calling it an ultra-premium ultrasound platform, which includes “advanced automated ultrasound fusion imaging as well as multi-modality review capabilities to provide additional clinical and spatial information in the analysis of complex pathology and when performing interventional procedures such as biopsies”.

The system features a comprehensive suite of elastography applications. Siemens introduced its latest applicant in this arena – the Virtual Touch tissue IQ, which enables the simultaneous display of a colour-coded tissue stiffness map and shear wave velocity measurements in a single image. This application allows immediate visual assessment of lesions and their stiffness characteristics, while providing simultaneous quantitative evaluation.

Siemens says that since its introduction in 2005, manual-compression eSie Touch elasticity imaging has been complemented by push-pulse Virtual Touch tissue software applications, Siemens’ proprietary implementation of ARFI (Acoustic Radiation Force Impulse) imaging. Virtual Touch tissue imaging and eSie Touch elasticity imaging create a visual stiffness map (known as an elastogram) via tissue compression. Complementing these two technologies, Virtual Touch tissue quantification additionally measures the propagation speed of shear waves to offer an industryfirst quantitative assessment of increased tissue stiffness – a frequent sign of pathology.

Siemens’ proprietary eSie Fusion imaging enables the automatic fusion of 3D computed tomography (CT) volumes with real-time ultrasound via a single click. Current fusion techniques require time-consuming manual registration of CT or magnetic resonance (MR) images. They also require the patient to lie motionless throughout the entire exam to avoid elaborate manual realignments. The automatic, one-click advanced registration capabilities of the Acuson S3000 system eliminate these limitations, reducing CT image registration to mere seconds and making it significantly easier for manual registration techniques to enhance workflow during MR volume registration.

One of the first physicians to test eSie Fusion, assistant professor Dr Dirk-André Clevert, section chief of the Interdisciplinary Ultrasound Center at Munich University Hospital Grosshadern, Germany, said: “Previously, the success of interventions was generally monitored by follow-up CT examinations. However, due to the new ultrasound fusion solution it should be possible to reduce the number of follow-ups done with CT. The use of fusion provides us with improved clinical information – without additional radiation. This is a great advantage for both the patients and the healthcare provider.”

The Acuson S3000 system features multi-modality review capabilities allowing CT and MR images to be imported into the ultrasound system for a quick, easy side-by-side comparison. This provides an additional layer of information to further increase diagnostic confidence and confirm therapeutic decisions.

The system is supported by the new high-density (HD) 8C3 HD transducer, specially designed for obstetrics and paediatric applications. Siemens points out that unlike conventional ultrasound transducer technologies, HD technology employs high-density ultrasound elements that deliver greater signal fidelity improving image compounding and providing the basis for noise- and clutter-free images with a high degree of contrast resolution and clear tissue differentiation.

The 8C3 HD transducer features a small footprint for improved surface contact and enhanced scanning performance. A 50% larger field-of-view enables the display of a full third-trimester foetal head, improving measurements and anatomic visualization.

The range of ultrasound transducers enabled on the Acuson S3000 also includes the recently introduced 6C1 HD highdensity probe for radiology, gynaecology and obstetrics, as well as the 18L6 HD probe for imaging in small parts, including the breast and thyroid.

Philips Healthcare’s Sparq

Philips Healthcare’s Sparq is a new point-of-care ultrasound system designed for emergency medicine, critical care, ultrasound-guided regional anaesthesia and pain medicine including nerve, spine, musculoskeletal, musculoskeletal superficial, vascular access, cardiac and TEE, and lung.

The key to this system is that it is easy to use. It has a simple design and an intuitive user interface.

Barry Nichols, consultant in anaesthesia and pain management, Taunton & Somerset NHS Foundation, Musgrove Hospital in the UK explains: “The simplicity of its design and the intuitiveness of its user interface make Sparq a pleasure to use. Its ergonomic controls and high resolution screen really benefit our clinicians’ dayto- day workflows. It is a compact and highly mobile device, and is perfect to use in the operating theatre environment.”

Philips says the device can be equipped with advanced service capabilities including online support, proactive monitoring to anticipate problems, utilization reports to help hospitals manage assets and increase efficiency, and remote desktop service, which allows for virtual on-site visits for both clinical and technical support.

GE Healthcare’s Logiq S8

The Logiq S8 is a lightweight, portable ultrasound system that fits easily into small exam rooms, can be easily transported within a facility and provides superb images across a variety of clinical areas including abdominal, breast, vascular, musculoskeletal and cardiology.

Built upon established Logiq technologies, the Logiq S8 helps provide excellent image quality and allows for a streamlined workflow that helps clinicians shorten exam times, as well as create consistent, highly detailed images that help increase clinical confidence. According to GE, the combinations of advanced features and system design help create the balance between performance and affordability. Its features include:

- S-Agile Ultrasound, a proprietary GE Healthcare technology that uses flexible clinically-based models of the body to help deliver consistently clear images for virtually all body types, and is particularly important given the growing number of overweight and obese patients who are being seen by healthcare providers;

- Scan Assistant, a software that allows for a streamlined workflow, enabling the operator to customise the system to perform frequently used functions automatically, helping to reduce busy work and exam times; and

- Extreme Ergonomics, which accommodates the stature and working style of sonographers, and helps reduce user fatigue and risk of injury, while enabling high-quality exams and efficient workflow.

Samsung Medison’s Accuvix A30

South Korean company Medison was acquired by Samsung last year. Now referred to as Samsung Medison, the company exhibited their new Acuvix A30 ultrasound system at Arab Health in Dubai in January. The system has a 21.5 inch LED monitor, touch controls and ergonomic design.

The large LED monitor enables high resolution colour imaging which improves the diagnostic capabilities when compared to the traditional black and white ultrasound monitors. The device uses the company’s proprietary ‘Color Opt Flow’ technology which supports quicker and sharper colour image representations of blood flow.

The Acuvix A30 supports ‘EZ Exam’ which transforms frequently used step-bystep exams into a single, faster and easier procedure.

Other features include ADVR, a feature of integrated real-time DVD recording which enables simultaneous scanning and recording. ‘QuickScan’ maximizes workflow efficiency by automatically optimising key imaging parameters with just a touch of a button.

‘DMR plus’ is a completely new engine that integrates Samsung software and enhances image quality. The ‘DMR plus’ engine uses a noise reduction filter to improve edge enhancement and contributes to better 2D image performance.

‘ElastoScan’ helps to detect malignant tumors and other diseases that typically are undetectable through conventional studies.

‘Thyroid ElastoScan’ offers an ElastoScan image without compression, using CCA pulsation. It also provides a quantification tool to measure the possibility of malignant nodules.

Speckle tracking echocardiology competes with MRI to quantify infarct size

Two studies presented at “EUROECHO and other Imaging Modalities” 2011 Congress in Budapest, Hungary, in December last year, demonstrate the potential for Speckle tracking echocardiography (STE), a recent echocardiography technique, to compete with the current gold standard of magnetic resonance imaging (MRI) in quantifying infarct size (IS) after ST-elevation myocardial infarction (STEMI).

“Up until now infarct size has only been measured as part of clinical studies and not in routine clinical practice. The reason being that the reference method of gadolinium based contrast agents in MRI is expensive, takes a great deal of time to perform, and can only be undertaken by imaging specialists,” explains EAE president Dr Luigi Badano, from the University of Padua, Italy. “The advantages of STE over MRI is that it’s far quicker to use, cheaper, and can be used by cardiologists at the bedside with portable machines, and repeated serially whenever needed.”

Additionally, STE can be applied even in patients with contraindications for MRI, such as metallic devices, claustrophobia, and severe renal failure that preclude use of contrast infusions.

“The studies presented here open the way for every patient who is admitted to hospital with STEMI to undergo assessment of infarct size with echocardiography prior to discharge,” says Badano.

Infarct size matters for determining how well patients will recover from STEMI. Statistics suggest that people who suffer damage to more than 30% of the left ventricle are twice as likely to die within a year of the event than people who suffer less damage.

“It’s well known that patients with larger infarcts are more likely to undergo alterations in the structure (dimensions, mass and shape) of the left ventricle, known as cardiac remodelling, which leads to heart failure,” says Badano.

Evidence is mounting, he adds, that screening for patients with larger infract sizes enables identification of patients with a worse prognosis who benefit from more aggressive therapy and more frequent follow-up visits. “Nowadays many more options exist for STEMI patients deemed at high risk of adverse events, including prescription of ACE inhibitors and insertion of devices like CRT cardiac resynchronisation or ICDs,” says Badano.

Speckle tracking echocardiography (STE) is a comparatively new non-invasive echocardiography technique well suited to quantifying infarct size. It works by tracking the movement of natural acoustic markers or “speckles” which are present on standard grey ultrasound tissue images. With the use of wall motion tracking software, speckle movement (and therefore myocardial tissue movement) can be visualised during the cardiac cycle. Speckle-tracking can be used to evaluate myocardial strain, which describes the myocardial deformation throughout the cardiac cycle. Reductions in measurement of strain, have been found to show direct relationships to the size of the infarct.

First use of 3D speckle-tracking to estimate infarct size following STEMI

Measuring circumferential strain with 3D speckle-tracking provides a good predictor of infarct size after STEMI, finds an Italian study¹.

In the study, which presents the first data on use of 3D speckle-tracking in measuring infarct size, Dr Denisa Muraru and colleagues from the University of Padua (Italy), estimated infarct size and necrosis transmurality in patients with recent STEMI, who had undergone successful treatment with primary PCI. One of the advantages of 3D speckletracking over 2D, say the authors, is that it allows the assessment of longitudinal (apex-to-base shortening), circumferential (shortening in the circumferential direction); radial strain (myocardialwall thickeningtowards LV cavity center) and area strain (a deformation parameter combining longitudinal and circumferential strain) at the same time. In the study, 49 patients with recent STEMI, successfully reperfused with primary PCI were assessed by 3D speckle-tracking, and the obtained LV strain parameters were compared with peak troponin I levels, as an estimate of the extent of myocardial cell injury. In a multivariable analysis, results showed that only circumferential strain emerged as a significant independent predictor of infarct size. Furthermore, in the subgroup of 27 patients who underwent additional assessment with delayed-enhancement MRI within 24 hours from the echocardiographic study, circumferential strain again showed the closest correlation with infarct size and the best predictive power to identify LV segments with transmural necrosis among all strain components.

“Our preliminary study demonstrates that 3D circumferential strain could be used as an accurate and reproducible marker for infarct size estimation by ultrasound in STEMI patients,” says Muraru. Long term follow-up, she adds, will be needed to verify if 3D strain parameters improve the predictive prognostic value of conventional parameters after STEMI.

Study uses 2D speckle tracking to predict infarct size

Longitudinal strain measured early after reperfusion with 2D speckle-tracking may predict infarct size and LV remodelling, concludes a Bulgarian study². In the study, Dr Krasimira Hristova and colleagues, from the University National Heart Hospital (Sofia, Bulgaria) investigated the ability of speckle-tracking echocardiography using the vector velocity imaging technique (which measures both the amount of strain and the direction of strain) to determine infarct size.

In the study 30 patients who had PCI for an acute MI within 24 hours and 20 normal volunteers (who had not experienced an event) were assessed with both vector velocity speckle-tracking and intracoronary electrocardiography. The later technique is an established procedure that maps areas of ischemia with guide wires during percutaneous procedures, providing the exact location and size of residual ischemia.

The results showed that in patients who had suffered STEMI radial and circumferential strain decreased in the infarct area, perinfarct area (immediate area around the infarct) and remote regions acutely in comparison with controls; but that longitudinal strain was only decreased in the actual infarct area and not in the perinfarct and remote regions.

“While longitudinal strain shows the best relationship to infarct size, we believe that radial and circumferential strain may be useful to predict the later development of adverse LV remodelling,” says Hristova.

In the next part of the study, she adds, they hope to be able to compare their initial results for longitudinal, radial and circumferential strain with the longer term effects on left ventricular remodelling.

References:

¹ D. Muraru, M Beraldo, E Solda, et al. Global 3D circumferential strain is related to infarct size and transmural extent of myocardial necrosis in patients with successfully reperfused STEMI. Abstract P283. http://spo.escardio.org/AbstractDetails.asp x?id=101168&eevtid=49

² K Hristova, D Vassilev, P Pavlov, et al. Clinical application of speckletracking echocardiography for assessing of infract size early after reperfusion in patients with acute myocardial infarction. Abstract P966. http://spo.escardio.org/AbstractDetails.asp x?id=101702&eevtid=49


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ate of upload: 24th Mar 2012

 

                                  
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