Paoli Hospital Tests New 3D Fluoroscopy Technology
Three-Way Research Partnership Moves Hologic 3D Hip Toward QDR Integration
Running the Numbers

Paoli Hospital Tests New 3D Fluoroscopy Technology

Atul Gupta, MD, director of the interventional radiology lab at Paoli Hospital, stands in the forefront with team members (from left) Dolores Nawrocki, director of imaging services; Suzanne Loprete, RN; Kathy Obyc, patient resource representative; (Gupta); Karen Babetski, RT(R)CV, supervisor, interventional radiology; and technologists Rod Hypolite, RT(R), and Tracy Arnold-Merke, RT(R).

Paoli Hospital (Paoli, Pa) is one of four hospitals in the United States testing new XperCT technology from Philips Medical Systems (Andover, Mass). The XperCT system—which is an added feature of the company’s Allura Xper FD20 x-ray system—combines 3D x-ray with CT technology to enable faster, safer interventional procedures. The system allows radiologists to roadmap with 3D images within the angiography suite, while exposing patients to less radiation than a traditional CT scan.

“In the old days, I used to have to go over to the CT scan and basically bring my office of supplies, and anesthesia, and needles, and wires, and catheters, and my team all that way,” said Atul Gupta, MD, director of the interventional radiology lab at Paoli Hospital. “It never made sense to me—why am I moving my whole office to another area? Now I can keep my office where it is, and I can create the image and do my intervention right there.”

The XperCT offers an alternative to CT scans—it displays the 3D data set acquired by the rotational scan facility of the Allura FD20 as axial images the correspond to conventional CT images. these can be viewed in any plane for guiding instruments during interventions, making it unnecessary to move the patient backward and forward to the CT scanner. The image reconstruction allows physicians to navigate with much greater accuracy through arteries in difficult regions, such as the brain or pelvis. “Before,” Gupta said, “we’d miss a stenosis or a narrowing of an artery because we only saw it in one or two projections. Now, when I do my 3D imaging, I can get a 360? revolution in every plane. I have much more confidence that I’m not missing anything.”

He described a case involving a patient with a brain aneurysm. “A team took an image of the brain right there in the angiography suite,” Gupta said, a procedure not possible in the past without moving the patient to a CT scanner. “The patient had a bleed, and when you’re bleeding in the brain, seconds count. The team saw it, and they were able to make the intervention right then and there, potentially saving this patient’s life.”

The XperCT completes its scan in 4 seconds. As processing speed has improved exponentially—the team at Paoli has been through three computer upgrades in 7 months—the time to create the reconstruction has gone from a full minute to almost nothing. “It’s on the screen immediately,” he said. “At 4 seconds, this is a no-brainer. If I have any sort of question, I do a 3D image.”

Gupta noted that radiation exposure is, as always, a concern. “That’s one of the biggest questions in my mind,” he said. “The latest data I’ve been told is that an XperCT scan generates about 70% as much radiation as a regular CT scan.”

XperCT technology also is being tested at Baptist Cardiovascular Institute (Miami), Yale-New Haven Hospital (New Haven, Conn), and Johns Hopkins Medicine (Baltimore).

—C. Vasko

Three-Way Research Partnership Moves Hologic 3D Hip Toward QDR Integration

Hologic Inc (Bedford, Mass) has announced its partnership with Klaus Engelke, PhD, head of the Osteoporosis Research Center at the Institute of Medical Physics, University of Erlangen-Numberg in Germany. Engelke’s participation marks the third point of a triangle, uniting him with both Hologic and researchers at Johns Hopkins’ Research Center for Computer Integrated Surgical Systems and Technology (CISST of Baltimore) in collaborative development of software called 3D Hip.

In October 2005, Hologic entered into an agreement with Russell Taylor, PhD, director of CISST, for the development of tomographic 3D image reconstruction of the hip. Researchers at CISST have since been working with Hologic’s Discovery technology, a dual x-ray absorptiometry device featuring a rotating C-arm.

Because the area around the hip is dense with soft tissue, however, segmentation of 3D hip reconstructions remains a challenge. That’s where Engelke comes in. “He’s well-known in CT circles for doing very high-resolution CT and getting the segmentation and the bone-density values correct,” said Hologic Scientific Director Kevin Wilson, PhD. “We’re pleased to have [the University of] Erlangen involved. They’re the best in the world at 3D reconstruction of CT hip scans and the segmentation thereof.”

Engelke’s data sets will be used in the development of volumetric reference data using Hologic’s QDR software. “Two-dimensional bone mass density works very well,” Wilson said, “but it explains only 60% to 70% of bone strength.” For the accuracy needed to predict fracture risk, researchers believe 3D analysis of bone strength is key.

“Once you have a 3D map of the density of the hip, as we’ll get with this 3D Hip system,” Wilson said, “then you can analyze it with finite element analysis”—the same process engineers use to measure the strength of bridges.

Added Brad Herrington, vice president of skeletal health imaging at Hologic, “Clinicians have long sought the next generation of osteoporosis-assessment tools to better predict femur-fracture risk. We believe this research will bring us closer to the commercialization of a low-dose tomographic assessment of bone density and geometry to discern bone structure and strength.”

—C. Vasko


Running the Numbers

30% of the worldwide radiography market is composed of digital x-ray systems, according to “Medical Imaging Markets, Volume 1: Radiography,” a new study from Kalorama Information (Kensington, Md). The report estimates that digital radiographic equipment?including x-ray and mammography?is expected to see double-digit growth in the United States through 2010. For more information, visit www.kaloramainformation.com.