· Breast MRI Brings Comfort to Massachusetts Patients
· First Installation! At Penn, Big Bore Is a Big Deal
· Research Alert 3D MRI: Promise for Detecting Diseased Arteries

Breast MRI Brings Comfort to Massachusetts Patients

Comfortable isn’t an adjective female patients typically use when describing their routine breast exams, but the word may very well become a popular one at the Beverly Hospital, located in Danvers, Mass.

Aurora?s dedicated breast MRI system was designed specifically with a woman?s anatomy in mind.

Since installing the Aurora 1.5T Dedicated Breast MRI System from Aurora Imaging Technology Inc, North Andover, Mass, earlier this summer, the community hospital’s Breast Health Center has scheduled patients daily for breast MRI screening.

“We’re very pleased to offer the convenience and comfort provided by the Aurora system,” said Christine Aiello, director, Radiology and Imaging services, Beverly Hospital. “Since the Aurora System was designed specifically with a woman’s anatomy in mind, it is more appealing to our clientele of female patients as the Aurora system is more sensitive to their needs and concerns.”

The Aurora system, which is the only FDA-cleared dedicated breast MRI system specifically designed for detection, diagnosis, and management, features a table design that can capture full coverage of both breasts, the chest wall, and axillae in a single scan. According to the company, the technology can accomplish this task without any compromise in image contrast or resolution.

Patients enter the modality with their feet first, minimizing feelings of claustrophobia. They can also rest on the massage-type table contoured specifically for breast anatomy. The emphasis on patient comfort helps to minimize the risk of patient movement, which therefore reduces motion artifacts on the image. Patients lie prone, with arms forward and down and breasts suspended away from their chest.

Peter Curatolo, MD, radiologist and acting medical director, Aurora Breast MRI of Beverly Hospital, described MRI as an emerging technology and commented on its present and future role at the center.

“The Aurora system plays a valuable role in the diagnosis of breast cancer at our facility and has been instrumental in the staging and treatment planning of patients with recent diagnoses of breast disease,” Curatolo said. “The Aurora system is an integrated component of our multidisciplinary center, and the feedback we’ve received from patients regarding our new service has all been very positive.”

The system is equipped with a computer-automated and fully integrated MRI-guided biopsy technology that determines needle placement, which Aurora says eliminates human error. It also delivers ultrathin 1-mm slices, resulting in the enhanced resolution and clarity that is ideal for detecting cancers missed through mammography or clinical examination.

“Early detection of cancer, through the help of advanced imaging technologies like the Aurora system, is the key to eradicating mortalities associated with breast disease,” said Olivia Ho Cheng, Aurora president and CEO. “Breast health centers nationwide are continually discovering the benefits of this important imaging modality. We proudly partner with Beverly Hospital to offer additional access to the Aurora System, to reach our mutual goal of winning the battle against breast disease.”

The most recent American Cancer Society guideline recommends breast MRI for women at high risk of breast cancer. The installation marks the fourth Aurora system in Massachusetts.

—Elaine Sanche

First Installation! At Penn, Big Bore Is a Big Deal

Earlier this year, Philips Medical Systems, Andover, Mass, released its new Gemini TF Big Bore PET/CT scanner, which features an 85-cm bore that allows clinicians to image patients in the same position as they are treated. First in line to install and implement the new system is the University of Pennsylvania’s Perelman Center for Advanced Medicine, in conjunction with the Abramson Cancer Center and the Roberts Proton Therapy Center.

Chaitanya R. Divgi, MD

“We ordered the system about 6 months ago, and I hope it will be fully operational by Thanksgiving,” said Chaitanya R. Divgi, MD, chief of nuclear medicine and professor of radiology at the University of Pennsylvania. “We’ll be using the system exclusively for radiation oncology, which is important. It represents a giant effort between oncology and radiology.”

Divgi explains that the large-bore system’s diagnostic accuracy wouldn’t be possible without time-of-flight technology. “The time-of-flight technology is what really made this system stand out,” he said. “With most PET units, there is a degradation in resolution as you move away from the center of the field of view. That’s not true of time-of-flight—it maintains resolution independent of the distance of the object from the center of the field of view.”

Large-bore systems for MR or CT are generally designed for bariatric patients or patients with severe claustrophobia, but in the case of PET/CT, a large bore is necessary even for many average-sized patients if clinicians wish to image them with a mold in place.

“Quite a few patients are unable to get into standard-bore PET/CT machines when they have a mold in place,” Divgi said. “The ideal way to do things is to image patients with a mold in place, and we’ll be able to do that very well with this system. Not only will we be able to use it for almost everybody who has a mold, we’ll be able to use it for almost everybody.”

Currently, Divgi estimates that around half of all lung cancer patients and a third of all abdominal patients at Penn cannot be scanned with molds in place because of bore size limitations. “Many of these patients are scanned, and we do software reconstructions of the mold in place, but then we’re making assumptions about the geometry,” he said. “This will enhance our radiation oncology offerings by giving a lot more of our patients the advantage of having their tumors scanned.”

Divgi and team hope to initially image 12 patients per day on the Gemini system, increasing that figure to 15 patients per day as time goes on. “That’s 15 a day with molds in place,” he added. “That may ultimately be unrealistic. We may do 10 a day with molds and five a day without. But our workday will be 15 patients.”

Divgi emphasizes that Penn’s acquisition of the device underscores the growing importance of interdisciplinary collaboration when it comes to cancer care. “Moving forward, we need to develop collaborations with areas like radiation oncology,” he said. “Molecular imaging and radiation oncology are increasingly important. It’s not just FDG anymore. We’re identifying many aspects of the tumor’s metabolism, and collaborations like this will significantly enhance our ability to deliver the best care and understand tumor growth in a way we haven’t been able to until now.”

—Cat Vasko

Research Alert: 3D MRI: Promise for Detecting Diseased Arteries

Radiologists can possibly utilize a new, 3D MRI technique as a screening tool to prevent stroke and heart attack, according to researchers at Sunnybrook Health Sciences Centre, Toronto.

The group is the first in the world to show how the noninvasive approach may detect a specific type of dangerous plaque in the arteries of high-risk patients. As a result, physicians may gain a closer, more in-depth look into diseased arteries and see information to which they did not have access previously. The researchers anticipate a potential change in “the standard of imaging everywhere.”

“There’s been a major sea change in our research,” said Alan Moody, MD, lead investigator and radiologist in chief in the center’s Department of Medical Imaging, who brought the 3D MRIPH technique to Canada from England. “We now know that the composition of carotid artery plaque is likely to be more predictive of future stroke events than the amount of narrowing in the blood vessel. Complicated plaque increases the risk of stroke or heart attack regardless of the degree of narrowing within the artery.”

Through magnetic resonance imaging of plaque hemorrhage, radiologists can detect the bleeding that occurs within a plaque in an artery. Moody explained that the detection of bleeding within the walls of diseased carotid arteries may allow physicians to stabilize the plaque before it causes a vascular event, such as stroke, heart attack, or death.

Moody and his team applied the technique on the carotid arteries of 11 patients, ages 69 to 81. They surgically removed complicated plaques from the patients’ diseased arteries and analyzed them under a microscope. Results of the study, which were published in the October 2008 edition of Radiology, demonstrated strong agreement between the lesions identified by the MRI as complicated plaques and the microscopic analysis of the tissue samples.

Conventional plaque-detection techniques include traditional ultrasounds, CT scans, and MRIs, which focused on the degree of narrowing of the blood vessel. On the other hand, the new MRI technique looks at the disease within the vessel wall, often before it causes significant narrowing. The researchers say the technique, therefore, serves as an early warning signal with the ability to flag a physician to a patient’s risk and allow them to treat the problem before it escalates into a full-blown blockage.

“This technology gives us information we’ve never had before,” Moody said. “It tells us how dangerous the plaque is and if it is likely to rupture. Until recently, we didn’t know the specifics about the type of blockage; we only went by how much narrowing it caused to the blood flow. If the narrowing was severe, it could be taken out surgically. Now, it can tell us information about the plaque before it is causing major problems.”

The researchers hope that the new technique can help select appropriate patients for plaque-removal surgery. The team is collaborating with scientists and clinicians across Canada through the Canadian Atherosclerosis Imaging Network to perform larger, more powerful trials.

—E. Sanchez