Governance, Mission, Growth

TomoTherapy Offers Stand-alone Solution
Teleradiology Business Benefits from MedQ Solution
Spotlight on Multispectral Imaging

The TomoTherapy Hi-Art treatment system provides IMRT, IGRT, and adaptive therapy for a wide range of cases.

TomoTherapy Offers Stand-alone Solution

Back in the 1990s, TomoTherapy Inc, of Madison, Wis, developed the TomoTherapy Hi-Art treatment system, a radiation therapy device with a built-in CT scanner that was designed to provide IMRT, IGRT, and adaptive therapy.

This past February, the company celebrated a milestone achievement, with its 200th unit being shipped abroad to Italy. Although the installation took place at a hospital—which represents the majority of its customers—Fred Robertson, the company’s CEO, pointed out that the technology also offers a unique solution for stand-alone centers.

“Stand-alone centers must be able to treat a wide variety of patient cases, efficiently and effectively,” Robertson said. “The Hi-Art treatment system is ideally suited for stand-alone centers because of the versatility of the machine and the high quality and range of patient treatments that can be performed. No other radiotherapy system has this flexibility.”

Robertson said the future of radiation therapy is incumbent upon the clinician’s ability to utilize image guidance and adapt the plan on a daily basis. Through the CT scanner, clinicians can image patients daily before each treatment, and then they can use the 3D images to determine whether treatment plan margins are still on target. Robertson said the ring gantry geometry makes it possible for 360-degree IMRT delivery utilizing a highly conformal treatment dose. With the system’s fully integrated Planned Adaptive software, true adaptive radiation therapy can be offered. This software helps in the evaluation of dose and the application of changes to the treatment plan.

“The TomoTherapy Hi-Art treatment system allows clinicians to treat a wide range of cases from head and neck, to breast, to prostate, to total body irradiation,” Robertson said. “Whether the case is simple or complex, the quality of a TomoTherapy treatment remains the same. Often, our competitors stumble upon this because with increasing treatment plan complexity often comes decreased quality.”

Robertson said his company equips clinicians with an advanced technology that has the ability to offer highly conformal treatments that spare normal tissue and hit targets tightly with intended doses. The process is completely integrated, from treatment planning to quality assurance, patient setup to treatment delivery.

The company is so sure of its TomoTherapy Hi-Art treatment system’s superiority that in March it issued a Treatment Quality Challenge that invited US cancer centers to demonstrate the ability to beat the quality of a TomoTherapy treatment plan using the RapidArc from competitor Varian Medical Systems. If proven, TomoTherapy will hand over $250,000 to the center.

Robertson said the challenge aims to “refocus the radiotherapy industry on what matters most: quality of patient treatments.”

Teleradiology Business Benefits from MedQ Solution

Four years ago, health care workflow solutions provider MedQ, of Dallas, changed the entire architecture of its RIS platform to accommodate more complex ordering information.

Its Q/ris 3000 Reading Services Management (RSM) System enables radiologists to create a single, consolidated worklist from a number of sites, from single modality centers to large hospital networks. Images, both digital and film, are automatically integrated into a seamless multivendor system, allowing radiologists to look at a single screen and read for a variety of imaging facilities.

“What we wanted to do was make it easy for doctors to take exams from multiple locations,” said John Norman, the company’s CEO.

For a company like Tennessee-based Mid-South Imaging and Therapeutics, PA. (MSIT), which operates a sub-specialized teleradiology business, the Q/ris was exactly the flexible solution the group was seeking to relieve staffers of time-consuming manual processes.

“As more physicians began placing MRIs, ultrasounds, and CTs in their own offices, they needed someone to read the images, and they would contact us,”said Melanie Fite, director of operations and marketing at MSIT, where she has worked for the past 15 years. “We needed one location to store all of our radiology reports and a solution that allowed us to track their progress and reduce turnaround time.”

Fite estimates that the teleradiology group reads 5300 exams a month from 20 different medical groups around the region. MSIT, with its group of 30 radiologists, provides services to Baptist Memorial Healthcare, in the metropolitan area of Memphis, Tenn. A computer and Internet access are all that is required for one of the group’s radiologists to access a worklist. The RSM offers data capture, editing, and electronic scanning, and it allows for both on-site and remote report creating using either digital dictation or voice recognition. “With our system, all a physician needs to do is sign on to the server and start dictating,” Norman said. “We can send the dictation automatically to multiple locations, depending on where the individual wants it.”

Fite said that since there are fewer manual processes, there is a lot less room for error. Data is captured once, at the source, and then the information is put into a complete reading package. One of the biggest benefits of the system, she continued, is that it distributes reports automatically. Some of the clinics want the reports faxed, Fite explained, while others prefer them encrypted in e-mail as a PDF. Sometimes, the client even requests that reports are placed directly into its server. “All of these processes, which we ourselves performed manually, are now automatic,” Fite said.

The Q/ris 3000 Reading Services Module is available as an integrated part of the Q/ris 3000 Enterprise Workflow Management System or it can be purchased as a stand-alone program to support the needs of radiology reading services. This flexibility was something that MSIT particularly enjoyed in the intuitive solution. Fite said that the group didn’t need an entire RIS with registration and patient schedule offerings. Essentially, MedQ was willing to sell them half of its system.

“They were so flexible and accommodating, especially with our customers,” Fite said. “They were willing to work with us on a per-clinic basis.”

Spotlight on Multispectral Imaging

Carestream Molecular Imaging, a division of Carestream Health Inc, recently unveiled an optical molecular technology that marks a significant advancement in today’s research activities and promises to enhance the future of patient care. Axis Imaging News spoke with William McLaughlin, the company’s director of research & development, about the new KODAK In-Vivo Multispectral Imaging System FX, which he described as “the only in vivo imaging system to provide multispectral unmixing of fluorescent imaging signals along with very high resolution x-ray imaging.”

IE: What is the significance of this new technology?

McLaughlin: This allows researchers to remove a tremendous amount of the autofluorescent background that causes problems in fluorescence imaging. It also provides the opportunity to monitor and measure multiple targeting agents in a single animal. Researchers have utilized this capability to identify tumor cells with one targeting agent at one wavelength, while assessing vasculature growth surrounding the tumor with a different targeting agent at another wavelength. These images can be combined with a high-resolution x-ray image to provide much more accurate localization of the two targets.

Another example of the use of multispectral imaging with x-ray has been with imaging stem cells in the bone marrow of mice. Our multispectral system provides excellent clarity of the fluorescently labeled cells, while the x-ray image accurately documents the specific location in the bone marrow. This is a very powerful combination.

IE: How does this improve on products already in the market?

McLaughlin: While it is well recognized in the optical molecular imaging industry that there is no single imaging modality that outperforms all others, the new multispectral system combines state-of-the-art fluorescent capabilities with x-ray and radioisotopic imaging modalities in one system. The system enables switching from one modality to another without moving the animals, thus providing the researcher with outstanding coregistration from one modality to another as well as the flexibility to employ a wide variety of labels and references.

IE: What were some challenges you faced in its development?

McLaughlin: The development of this system was very challenging and required ingenuity on the part of our R&D teams. The selection and management of the best optically qualified materials, along with very specific high-quality patented filter assemblies, are critical to keeping the overall fluorescent background of the system as low as possible. This allows us to provide the best signal-to-background at each of the hundreds of possible excitation and emission wavelength combinations. Better signal-to-background in each channel enables the detection of smaller amounts of the targeting agent, as well as enhanced unmixing between two or more agents.

The development of specialized software to unmix the different fluorescent wavelengths was also required. We demanded software that could not only allow researchers to unmix and visualize the different fluorescent components in an image, but also allow accurate measurement of these signals. Our talented software group leveraged their years of experience in image analysis in the biotechnology and astronomy fields to develop software that models and stores the measured fluorescent spectra for each imaging agent and allows repeated use of the same models to ensure consistent measurement of each imaging agent across animals and over time. Automated calibration, normalization, and field flattening routines were also very important to achieve the level of outstanding quantification featured in the new multispectral platform.

Finally, the resolution of the x-ray imaging capabilities has improved tremendously over the last 2 to 3 years. We applied a long history of Kodak’s expertise in coating technologies to provide the thinnest possible x-ray imaging screen, which ensures outstanding resolution. We now can show well over 25 line pairs per millimeter, a significant improvement over standard digital x-ray systems that typically provide about 10 line pairs/mm resolution. This kind of resolution allows researchers to use the x-ray system not only for localization of fluorescent or luminescent signals in the animal, but also to identify morphological changes caused by changes in disease states.

IE: What impact does this technology have on the future of medical imaging?

McLaughlin: Optical in vivo molecular systems are widely used today in medical animal research for drug discovery and development. Researchers are able to evaluate the effectiveness of drugs by seeing changes in cells day to day, instead of viewing changes over a period of several weeks. Because of the lower cost and greater stability offered by optical technology, we expect to see optical molecular systems used in human drug clinical trials in about 2 years, which will pave the way for widespread clinical use in hospitals all over the world.

The technological advances represented by the In-Vivo Multispectral System can be incorporated into optical molecular imaging systems used for clinical imaging applications. The multispectral unmixing capabilities will help minimize and normalize different types of background in different types of organs or different types of skin. This will enable significant improvement in the measurement of targeted fluorescent imaging agents in human applications both from noninvasive surface imaging as well as with surgical or endoscopic approaches.

IE: What is the difference between the optical molecular technology found in the multispectral system and existing molecular systems such as PET?

McLaughlin: Traditional molecular systems like PET, although useful, are extremely expensive. Further, the radioactive reagents used require a difficult and expensive production process. These agents also have a short shelf life and must be delivered quickly from the lab to the patient in order to be effective. In contrast, optical molecular imaging offers moderately priced systems and dyes that are nontoxic, highly specific, and affordable. Although optical molecular technology is not yet widely used in the clinical setting, its research applications clearly indicate that it will offer substantial advantages to hospitals and ultimately patients.