· Keeping CR Equipment Current
· LipiScan Launch: New Hope for Heart Patients
· ACRIN Results: Effectiveness of Mammo Plus Ultrasound
· Konica Comes to the Rescue

Keeping CR Equipment Current

Select KODAK CRSystems include Carestream Health’s new CR operating software with new KODAK DIRECTVIEW EVP Plus Image Processing Software

If your CR units aren’t the newest ones on the block, they may be functioning just fine but lack some of the newer features. Well, if those units happen to be select models from Carestream Health, you may be in luck. KODAK DIRECTVIEW EVP Plus software from Carestream Health, Rochester, NY, provides current users of the CR 825, CR 850, and CR 975 with the same advanced capabilities as those given to new customers.

The enhanced image-processing software, released in November with the commercial availability of the company’s CR Classic and CR Elite, is included with the purchase of either of the two new solutions. And, since January, it has been made available to existing customers as a retrofit.

“Customers who have bought Kodak Carestream CR over the last 3 to 4 years can very easily modernize their equipment to have the same features, functions, benefits, and optimized customer workflow today as the brand-new buyer obtains tomorrow,” said David Kennedy, CR product line manager for Carestream Health.

Kennedy said the software allows for the automatic presentation of images that have been optimized for the preferences the customer has expressed. Designed with time-saving features that reduce capture setup times, the software enables the enhancement of the overall image quality. Of utmost importance to clinicians, a key improvement to the previous version of the software is in the consistency of results, Kennedy continued.

“We’re speaking of the ability for the algorithms to render the image from whatever input you give it into the format you are seeking,” Kennedy said. “It can handle slight underexposures to slight overexposures. It can handle images that might be shot at a lower kV and less penetrating dose that what might be optimal. We can transform a suboptimal exposure into an optimal image much more consistently than has ever been performed before.”

Another software upgrade occurs before the technology even enters the facility’s doors. In advance of installing a Carestream CR system, the company sends the customer a DVD-based tool from which they can review images of different body parts under a variety of renderings. From contrast to sharpness, detail to latitude, customers can indicate their general preferences prior to installation. Then, after the machine is set up, it will deliver the preferences out of the box without a need for configuration.

Additionally, a distinctive feature of Carestream’s image processing are the tools the software offers to customers. Akin to a sound control on an old stereo or an equalizer, sliding bars permit users to make easy adjustments, independent of all the others. The full range of exposure data can be exploited in a mutually exclusive way. “That’s rather unusual in the image-processing world, where typically you make a change in one item, and you may have to make a compensating offset in another,” Kennedy said. “In our case, we made it very simple for our customers.”

Also, the solution makes it possible for users to automatically render images without a prior knowledge of exam or body part, what the company refers to as “body part independent image processing.” Multiple exposures can be readily accommodated and processed independently.

With the latest software upgrade, Carestream intends to reach out to a wider range of users: customers looking for an easy-to-use full turnkey solution, those with potentially conflicting preferences among their physicians, and other more advanced users with very exacting details they seek to achieve.

“We feel comfortable that our EVP Plus product accommodates both those customers who are looking for simple turnkey ultraefficient workflow without a great deal of training involved, and also, at the other end of the spectrum, which is for the sophisticated facility that has medical physicists who are fine-tuning in accordance with the subjected preference of their readers,” Kennedy said.

LipiScan Launch: New Hope for Heart Patients

Physicians at a hospital in Michigan have successfully identified the chemical composition of plaque deposits on artery walls using a laser-imaging device that could help in the treatment of heart patients, according to the company that built the device.

The LipiScan Coronary Imaging System that physicians used in a cardiac catheterization procedure is manufactured by InfraReDx, a company based in Burlington, Mass. The device uses laser light to detect how much fat is contained in plaque on artery walls, allowing physicians to identify fatty, or “lipid core” coronary plaques.

It’s important for physicians to identify which plaques have lipid cores, because if one of these fat-filled plaque deposits ruptures it can cause a heart attack by cutting off blood and oxygen. “This device really opens up a whole new era of clinical research to determine how we treat patients best,” said Simon Dixon, MD, director of the cardiac catheterization laboratories at the Michigan-based Beaumont Hospitals.

Dixon and colleague Jim Goldstein, MD, used the LipiScan system for the first time on a patient on May 8, in a procedure at Beaumont Hospital, Royal Oak, after the FDA approved the device in April.

Based on an angiogram showing a narrowing of a coronary artery, physicians planned to deploy a stent, which is a tiny mesh scaffold, in one of the patient’s main coronary arteries to hold open the artery. But after physicians used the LipiScan device and discovered the patient, a 70-year-old man, had a lipid core plaque near where they were going to place the stent, they decided to use a longer stent to also cover the fatty plaque. A stent that terminates in a fatty plaque can get clotted up years after placement, according to InfraReDx.

Within less than 2 weeks of performing that first procedure, physicians with Beaumont Hospitals had performed a half-dozen cardiac catheterization procedures on heart patients using the LipiScan Coronary Imaging System.

“I think the device has performed very, very well, and the information from the device has really been very helpful in terms of our clinical decision-making,” Dixon said. Aside from helping physicians determine what length of stent to use and where to place it, the LipiScan device also could help physicians study when to use a stent on lipid core plaque in the first place, Dixon said. If a patient has mild narrowing of a coronary artery that would not normally require a stent, but the narrowing has lipid core plaque, physicians may opt to use a stent to treat that narrowing, he said.

“We do know that lipid core plaques are more prone to rupture and cause heart attacks and clinical problems,” Dixon said. “We don’t know if prophylactically treating those with stents will reduce problems in the future, so that’s the next clinical area to work out.” The LipiScan device also could help determine if patients benefit most from bare-metal stents or the stents with time-released drugs intended to prevent plaque from squeezing in around them, Dixon said.

The LipiScan system is the result of a decade of biomedical engineering, according to InfraReDx. It uses advanced optical technology, much of it developed for telecom uses, to deliver and retrieve near-infrared light from coronary plaques in patients undergoing cardiac catheterization. The light reflected back at different wavelengths is analyzed to detect the chemical composition of coronary plaques.

Once the imaging window is inserted into a coronary artery, it is slowly pulled back and out of the artery. Within a minute, the device can allow physicians to see whether or not a patient has lipid core plaque in the artery, Dixon said. “It’s essentially instantaneous information, so we can use that at the bedside to help treat these patients,” he said.

ACRIN Results: Effectiveness of Mammo Plus Ultrasound

W. Phil Evans, MD

Performing an ultrasound exam in addition to mammography, rather than mammography alone, may improve cancer detection in women who have an elevated risk of breast cancer, according to findings from the first round of screening in the American College of Radiology Imaging Network’s ACRIN-6666 trial.

However, results from the multicenter trial also indicated that single screening ultrasound used with mammography also can increase the number of false positives.

“Whether or not the risk of false positives will diminish with subsequent rounds of the screen trial remains to be seen, but it’s something we’re tracking,” said W. Phil Evans, MD, study author and a professor of radiology at the UT Southwestern Center for Breast Care, Dallas.

Presented in the May 14 issue of JAMA: The Journal of the American Medical Association, the recent findings are based on the results of more than 2,800 participants at high risk of developing breast cancer. The median age of the participants was 55 years old, and more than half had a personal history of breast cancer.

Forty participants were diagnosed with breast cancer. Of those cases, 12 lesions were suspicious only on ultrasound, eight suspicious on both ultrasound and mammography, and eight on neither.

Seeking to compare the effectiveness of using the combination of ultrasound screening and mammography versus mammography alone, the trial ran from April 2004 to February 2006. In the trial, 2,809 women with at least heterogeneously dense breast tissue in at least one quadrant were recruited from 21 sites to undergo the combined procedures in randomized order by a radiologist masked to the other exam results. The diagnostic yield for mammography was 7.6 per 1,000 women screened and increased to 11.9 per 1,000 for combined mammography plus ultrasound. The supplemental yield was 4.2 per 1,000 women screened. Additionally, the diagnostic accuracy for mammography was 0.78, increasing to 0.91 for mammography plus ultrasound.

According to the report, 11 of the 12 supplemental cancers detected by ultrasound alone were invasive with a median size of 10 mm, and eight of the nine lesions discovered had negative nodes. The article goes on to say that the positive predictive value of biopsy recommendation after full diagnostic workup was 19 of 84 for mammography, 21 of 235 for ultrasound, and 31 of 276 for combined mammography plus ultrasound.

Potential candidates were excluded if they had signs or symptoms of breast cancer; had recent surgical or image-guided breast procedures; had breast augmentation; or who were pregnant, nursing, or planning to become pregnant within 2 years of study entry. Furthermore, they were ruled out if they had undergone MRI or tomosynthesis within the past year or mammography or whole breast ultrasound within 11 months.

Evans said the availability of ultrasound makes the modality attractive for supplemental screening, in addition to its tolerance by patients and lack of radiation. Moreover, it is less costly than MR.

The American Cancer Society recently recommended that an annual breast MRI be used in addition to mammography for screening women at very high risk of cancer. These guidelines do not apply to the large number of women who are considered to be at intermediate or high risk for developing breast cancer but who not eligible for MRI.

The Avon Foundation and the National Cancer Institute supported the work.

Konica Comes to the Rescue

Regius CR units helped rehab hospital improve efficiency.

Debi Farnham spent last Christmas at work, hanging film after film for physicians at Enloe Medical Center, with two campuses including two outpatient centers and a rehab hospital all located in Chico, Calif.

“Turnaround times were horrible,” she explained, adding that the facility had received physician complaints. “When I worked up front, I found at least 25 jackets that were hidden, unable to locate priors. Film library staff was not dependable or engaged. Radiologists were constantly complaining that boards were not hung, or hung incorrectly.”

The director of medical imaging shudders to think back to a time, not too long ago, when her work environment was hectic and inefficient. Those days are now just distant memories, after the facility purchased a REGIUS CR unit from Konica Minolta, Wayne, NJ.

“We stopped printing from day 1,” Farnham said, pointing out that later, when administrators toyed with the idea of reverting back to film temporarily prior to launching a new PACS, the staff voiced its reluctance. “No one wanted to go back,” she continued. “The image quality was so much better that the radiologists were actually overreading images. They were seeing so much more detail that it appeared abnormal.”

The medical center couldn’t get enough of the technology. It purchased four more CR units, as well as a single-plate REGIUS Nano CR, for the main campus. Two CR readers were placed in the main department, one in the trauma room, one in the ICU/CCU, and the Nano in the operating room. Furthermore, there is one Regius CR and one Nano at the Enloe Outpatient Center and same-day surgery facility, which includes outpatient surgery, occupational health, preop screening, and a walk-in clinic. Moreover, the medical center installed two more Nanos for the x-ray department of its Cohasset campus, the medical center’s sister campus, which includes a walk-in clinic, a behavioral health facility, and an orthopedic clinic.

Farnham is pleased with the units’ many benefits. Training required only a few hours. The old darkroom was transformed into a storage and break room. The old film library is no longer taking up space. Physicians now have instant access to images. The image quality is greatly improved, the price was affordable, and the technology integrates well with most PACS, she said.

“We wanted redundancy at all sites,” Farnham said. “The Nano gave us the ability to afford two units instead of just one at these sites. Redundancy is always important in our business. We need a backup plan at all times. Having two CR readers at the location gives us that peace of mind.”

Most importantly for Farnham, radiological technologists can unjam the machines. “I know my techs, and this played a huge role,” Farnham said. “If there’s a jam, the tech can just open it up. The ability to unjam the machine instead of calling the service was just huge.”

Farnham isn’t the only customer happy with Konica’s products. In a recent report from independent health care research firm KLAS Enterprises, the company’s REGIUS Nano CR was named the “Best in KLAS” among single-plate CR systems from five vendors. Konica was awarded the top ranking in the categories of console/tech software, throughput, and cassette/plate quality, and it tied for first in image quality. Konica also received the top ranking in the “Ranked client’s best vendor” category.