ICUS Weekly News Monitor 12-2-2016

  1. MedicalXpress,  Nov 30, 2016,  Faster, non-invasive method to determine the severity of a heart failure   (Eindhoven University of Technology)

  2. DOTmed.com, Healthcare Business,  Nov 29, 2016,  Physicians at RSNA make case for contrast-enhanced ultrasound by John W. Mitchell

  3. Breast Cancer News,  Nov 9, 2016,  Mammogram Alternative Would Be Radiation-Free, Less Uncomfortable     By Ines Martins, PhD

 
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MedicalXpress
Nov 30, 2016
 
Faster, non-invasive method to determine the severity of a heart failure
Provided by: Eindhoven University of Technology
 
Methods currently employed to determine the severity of a heart failure are very limited. Researchers at TU/e and the Catharina Hospital in Eindhoven have therefore developed a method that is very quick, non-invasive, cost-effective and can be performed at the hospital bedside. Moreover, this method appears to have a predictive value for whether or not a double pacemaker will be successful. Researchers Ingeborg Herold and Salvatore Saporito received their doctorates earlier this month for their study.
 
Heart failure – when the heart is no longer able to pump enough blood through the body – is a very common problem. To get the right treatment, it is important to measure how well the heart is still able to do its job. There are currently various methods for doing this, but all have their limitations. Sensors often need to be placed in the large arteries, via the shoulder or neck, and that is quite an invasive procedure. MRI is a possibility, but not for patients that are seriously ill. Patients that are short of breath nearly always undergo blood analysis, a method that examines the concentration of a particular protein in the blood and provides a very good, patient-friendly indicator, but it takes several hours before the outcome is known.
 
The Eindhoven researchers have developed a patient-friendly method that uses an echo scanner, which is known mainly for echoes performed during pregnancy, to determine the severity of heart failure. To do this, they measure the time it takes for the blood to travel from the heart's right ventricle through the lungs to the left ventricle, which is responsible for pumping oxygenated blood through the body. In order to measure this pulmonary transit time (PTT), they inject harmless microbubbles that can be seen clearly by the echo scanner. They then look at the heart and see how long it takes for the bubbles to get from the right to the left ventricle.
 
It may seem simple enough but there was a significant scientific challenge in calculating an unequivocal PTT for the observed microbubbles that get dispersed in the blood flow. But once that had been solved, they compared the transit time with a number of existing indicators, developing a similar method on the basis of MRI. Comparisons revealed that the PTT measured with the echo scanner provides an excellent indicator for the severity of a heart failure. A healthy heart pumps the blood quickly through the lungs. The longer the PTT, the less well the heart performs. They examined subjects whose heart muscle no longer contracted well, which is the most common type of heart failure. Before the method can be used, there is still work to be done. For example, if it is to be both practical and fast, the analysis will have to be automated.
 
Another aspect being studied is the extent to which the PTT is able to predict the success of a double pacemaker, whose primary objective is to restore the synchronicity of the two ventricles of the heart. Herold indeed found that there was a fairly firm relationship between the transit time and the success rate. The breaking point is 12.5 seconds; above that, the chance of the pacemaker enabling the heart to perform better reduces. But any application of this indicator requires more research, says Herold. Because the method does not appear to be completely accurate in the prediction, she expects it to be useful in combination with other indicators.
 
The method is founded on the work of TU/e researcher Massimo Mischi, who has spent a decade working on the development of 'contrast enhanced ultrasound (CEUS)' for analyzing the blood flow using microbubbles as a contrast medium. He has already done this successfully to detect prostate cancer.
 
Ingeborg Herold gained her doctorate on Thursday 17 November for her thesis 'Assessment of cardiopulmonary function by contrast enhanced echocardiography' while Salvatore Saporito received his PhD the same day for his thesis 'Cardiovascular MRI quantifications in heart failure'.
 
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DOTmed.com
Healthcare Business
Nov 29, 2016
Physicians at RSNA make case for contrast-enhanced ultrasound
by John W. Mitchell
 
Physicians from the U.K., Canada and Italy presented case studies from their use of contrast enhanced ultrasound (CEUS) at the RSNA meeting in Chicago.
The procedure, which was OK’d by the FDA this year for liver screening, but is currently not approved in the U.S. for cardiac disease, shows particular value in imaging children who may otherwise have to
 
Dr. Paul Sidhu, a radiologist and professor at King’s College in London, made the case that adopting CEUS is as much a philosophical choice as clinical.
“One of the main reasons to adopt CEUS is to reduce radiation burns that we seem to inflict upon our patients,” he told a large Monday morning audience at a Samsung-sponsored event.
 
He noted the use of CT scans in the U.S. has risen from about three million in 1980 to roughly 80 million in 2015. This is troubling, he noted, as it’s estimated that between 1.5 and 2 percent of cancers, including leukemia, in the U.S. may be attributed to organ dose radiation from CT exams. CEUS offers a radiation-free alternative to CT scanning in diagnosing liver ailments and injuries.
 
Based on his experience, he said that CEUS has several advantages over CT, as well as MR. CEUS can be performed immediately, with no lab testing. It is also portable and can and it can be conducted at multiple locations, such as the bedside, operating room or in the CT suite. It also operates and provides results in real time, allowing rapid changes to be recorded.  He also reported lower adverse rates than for CT or MR.
 
The addition of a contrast line into a venous line does require two operators and the use of the contrast adds almost five minutes to the procedure, but according to Sidhu, the image study results are worth the trade-off. He cited a journal article that concluded: “CEUS and MR are of equal value for the differentiation and specification of newly discovered tumors in clinical practice.”
 
Another speaker at the event, Dr. Stephanie Wilson, professor of radiology at the University of Calgary, Canada, spoke about her one-week conducting these procedures using the Samsung RS80A with Prestige. She reported very competent diagnostic capabilities for cirrhosis patients and said that using color Doppler was especially helpful in liver diagnosis of obese patients.
 
“While none of these findings have yet been confirmed (due to the short amount of time she had the machine before the conference) ... I think the findings will be confirmed,” Wilson told the audience, adding that she would present these results and other findings on CEUS diagnostics at next year's RSNA meeting.
 
The final presenter, Dr. Vito Cantisani, an Italian cardiologist, presented findings on his success using CEUS in diagnosing different types of heart plaques (an application that is not currently approved in the U.S.). He noted that cardiovascular disease contributes up to 10 percent of deaths worldwide, and diagnosing plaques is critical in reducing heart attack and strokes.
 
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Breast Cancer News
Nov 9, 2016
Mammogram Alternative Would Be Radiation-Free, Less Uncomfortable
By Ines Martins, PhD
 
Researchers are working to develop a new breast-friendly, radiation-free method that may replace the unpleasant mammogram currently used to detect breast cancer.
 
The new method, described in the study “Towards Dynamic Contrast Specific Ultrasound Tomography,” and published in Scientific Reports, uses ultrasounds to provide 3-D images of the breast, and is meant to reduce not only a woman’s discomfort during the procedure, but also the number of false-positive results seen frequently with current mammogram methods.
 
Currently, women are screened for breast cancer through a mammogram, where the breast is squeezed tight between two plates to generate 2D X-ray images. The method is not only physically unpleasant and one of the reasons women choose to skip screening, it also comes with the risk that the radiation used in the mammograms can contribute to the development of cancer.
 
In addition, mammograms generate large numbers of false-positive results. In more than two-thirds of cases where doctors find an abnormal tissue that is recommended for biopsy, it turns out that the abnormal regions are not cancer. In the meantime, women are subjected to high levels of unnecessary worrisome stress.
Researchers have been trying to develop alternatives to this method that provide more accurate results and that reduce women’s discomfort. Recently, a team at Eindhoven University of Technology has been working on a possible alternative for mammograms.
 
According to a press release, the new technology requires patients to lie on a table with their breast hanging freely in a bowl. Using ultrasounds, a 3-D image of the breast is generated and scanned for tumors. The researchers believe this method will generate far fewer false negative results.
 
The technology builds up on a patient-friendly prostate cancer detection method also developed at the Eindhoven University of Technology. The approach takes advantage of the distinct vessel architecture found in tumors and healthy tissues. Tiny micro-bubbles that can be precisely monitored with an
echoscanner are injected in the prostate blood vessels, allowing doctors to precisely identify the presence and location of the tumor.
 
Although this method is now being tested for prostate cancer in hospitals worldwide, breast motion and size have largely limited its application in breast cancer screening.
 
But researchers may have developed a new variant of the echography method that is suitable to be used in breast cancer. Libertario Demi, Ruud van Sloun and Massimo Mischi developed the Dynamic Contrast Specific Ultrasound Tomography, which uses the same micro-bubbles, but under a different principle. They use the fact that bubbles vibrate in the blood at the same frequency as the sound produced by the echoscanner, and at twice that frequency — the second harmonic.
 
When the scanner captures that vibration, it knows where the bubbles are located. Similar to the micro-bubbles, the body tissue also generated harmonics, which limited the researchers’ observations. But the researchers found that, contrary to the body tissues, the gas bubbles delayed the second harmonic. And the more bubbles the sound-waves encountered, the bigger the delay.
 
This, however, can be detected only if the sound is captured on the other side, which makes the technology ideal for the breast tissue.
The researchers are now starting a collaborative effort to conduct preclinical studies with the new tool, and hope it will be included in clinical practice within 10 years, possibly in combination with other methods that will generate high-quality images that allow for highly accurate diagnoses.

ICUS Weekly News Monitor 11-4-2016

1.  Medical Xpress,  Nov 3, 2016,  Breast-friendly, radiation-free alternative to mammogram in the making
 
2.  BCC Research,  Nov 1, 2016,  Technology Powering Growth in Global Markets for Medical Ultrasound Devices, Reports BCC Research
 
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Medic al Xpress
Nov 3, 2016
 
Breast-friendly, radiation-free alternative to mammogram in the making
 
Each year around a million women in the Netherlands undergo mammograms for early detection of possible breast cancer. It's an unpleasant procedure that uses X-rays. Researchers at Eindhoven University of Technology are working on a 'breast-friendly' method, without radiation, that is more accurate and generates 3D rather than 2D images. They published their proof of concept last month in the online journal Scientific Reports.
 
In the regular screening method the breast is squeezed tight between two plates in order to produce one or more good X-ray photos. Apart from being unpleasant, it is not without risk. The X-rays used can themselves be a contributor to the onset of cancer. Moreover, it is often unclear whether the anomaly found is a cancer or not. More than two-thirds of the cases where something worrying can be seen on the X-ray photos is false-positive: after the analysis of biopsies they are not found to be cancers. This is why science is seeking alternatives.
 
Researchers at TU Eindhoven have now cleared a major scientific hurdle towards a new technology in which the patient lies on a table and the breast hangs freely in a bowl. Using special echography (inaudible sound waves) a 3D image of the breast is made where cancer can be identified; the researchers therefore expect there to be many fewer false-positive results.
 
The new technology builds on the patient-friendly prostate cancer detection method developed at TU/e whereby the doctor injects the patient with harmless microbubbles. An echoscanner allows these bubbles to be precisely monitored as they flow through the blood vessels of the prostate. Since tumors and healthy tissue have different blood vessel structures, the presence and location of tumors become visible. This method works well for the prostate and this is now being widely tested in hospitals in the Netherlands, China and, soon, Germany. For breast cancer the method had not yet been suitable due to motion and because the breast is too large, which seriously limits the possibilities of a standard echoscanner.
 
Researchers Libertario Demi, Ruud van Sloun and Massimo Mischi have now developed a variant of the echography method that is suitable for breast investigation. The method is known as Dynamic Contrast Specific Ultrasound Tomography. Echography with microbubbles uses the fact that the bubbles will vibrate in the blood at the same frequency as the sound produced by the echoscanner, as well as at twice that frequency; the so-called second harmonic. By capturing the vibration, you know where the bubbles are located. But body tissue also generates harmonics, and that disturbs the observation.
 
For the new method the researchers are using a phenomenon that Mischi happened upon by chance and later investigated its properties together with Demi. They saw that the second harmonic was a little delayed by the gas bubbles. The researchers have now developed a new visualization method. The more bubbles the sound-wave encounters on its route, the bigger the delay. By measuring the delay, the researchers can thus localize the gas bubbles and do so without any disturbance because the harmonic generated by the body tissue is not delayed, and is therefore discernible. This difference, however, can only be seen if the sound is captured on the other side. So this method is perfectly suited to organs that can be approached from two sides, like the breast.
 
The researchers are currently putting together an international, strong medical team to start performing preclinical studies. Application in practice is certainly ten or so years away, Mischi expects. Moreover, he forecasts that the technology that has been developed will probably not operate on a standalone basis but in combination with other methods, which will create a better visualization. One of the candidates for this elastography, a variant of echography whereby the difference in the rigidity of the tumor and healthy tissue can be used to detect cancer.
 
 
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BCC Research
Nov 1, 2016
 
Technology Powering Growth in Global Markets for Medical Ultrasound Devices, Reports BCC Research
 
Recent advancements in ultrasound technology include the wireless and immediate transmission of images using applications and dedicated cloud servers. BCC Research reveals in its new report that this trend toward inexpensive, portable, and wireless ultrasound imaging is helping move the global markets for medical ultrasound devices.
 
Diagnostic ultrasound, also called sonography or diagnostic medical sonography, is a noninvasive imaging method that utilizes high-frequency sound waves to produce images of structures within your body.
 
The global market for medical ultrasound devices is expected to reach $9.9 billion by 2021, up from $7.3 billion in 2016, reflecting a five-year compound annual growth rate (CAGR) of 6.4%. The Asia-Pacific market, the largest and fastest-growing market, should reach $2.4 billion and $3.7 billion in 2016 and 2021, respectively, demonstrating a five-year CAGR of 9.5%. The Latin American market, the second-fastest growing market with an anticipated five-year CAGR of 8%, should grow from $576 million in 2016 to $847 million in 2021.
 
Recent innovations include hand-carried ultrasound (HCU) units, advances in three-dimensional (3-D) and four-dimensional (4-D) ultrasound imaging, improvements in image quality, and the use of ultrasound contrast agents to improve sensitivity for the detection of tumors. Another key development is the emergence of sonoelastography to help diagnose liver fibrosis staging, thyroid nodules, and lymph node and indeterminate breast lump characterization.
 
Technological advances in diagnostic ultrasound imagery have significantly improved patient diagnostics by providing immediate clinical information. These rapid advances are directly related to the parallel advancements in electronics, computing and transducer technology together with sophisticated signal processing techniques. The availability of instantaneous diagnostic data has helped reduce overall healthcare costs by replacing more expensive diagnostic examinations.
 
"One of ultrasound's key advantages over other imaging modalities is its increasing mobility," says BCC Research analyst Paul Taylor. "From innovations such as portable handheld devices to the world's first wireless transducer, ultrasound can quickly image internal organs such as the heart, kidney and liver, without being impeded by cables or bulky machines. This key feature of ultrasound not only improves the point of care at hospitals, but also the public's access to medical imaging, especially in developing regions where it is needed."
Medical Ultrasound Devices: Techs and Global Markets (IAS040B) analyzes the values, growth rates, shares, dynamics, and factors of major market and submarkets. Global market drivers and trends, with data from 2015, estimates for 2016, and projections of CAGRs through 2021 also are provided.
 
Editors and reporters who wish to speak with the analyst should contact Steven Cumming at This email address is being protected from spambots. You need JavaScript enabled to view it. .
 
About BCC Research
BCC Research is a publisher of market research reports that provide organizations with intelligence to drive smart business decisions. By partnering with industry experts worldwide, BCC Research provides unbiased measurements and assessments of global markets covering major industrial and technology sectors, including emerging markets. Founded in 1971, BCC Research is a unit of Eli Global, LLC. For more information about BCC Research, please visit bccresearch.com. Follow BCC Research on Twitter at @BCCResearch.

ICUS Weekly News Monitor 10-27-2016

1.  URO Today ,  Oct 22, 2016,  Ultrasound-contrast-agent dispersion and velocity imaging for prostate cancer localization.      Authors:  Ruud Jg van Sloun, et al
 
2.  DotMed, HealthCareBusiness Daily News,  Oct 7, 2016,  GE ultrasound contrast agent Optison gets FDA OK for label change        by Thomas Dworetzky
 
 
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URO Today
Oct 22, 2016
PubMed http://www.ncbi.nlm.nih.gov/pubmed/27723564
 
Ultrasound-contrast-agent dispersion and velocity imaging for prostate cancer localization.
 
Authors:
Ruud Jg van Sloun, Libertario Demi, Arnoud W Postema, Jean Jmch de la Rosette, Hessel Wijkstra, Massimo Mischi
 
Lab. of Biomedical Diagnostics, Eindhoven University of Technology, the Netherlands. Electronic address: This email address is being protected from spambots. You need JavaScript enabled to view it. ., Lab. of Biomedical Diagnostics, Eindhoven University of Technology, the Netherlands., Academic Medical Center University Hospital, Amsterdam, the Netherlands., Lab. of Biomedical Diagnostics, Eindhoven University of Technology, the Netherlands; Academic Medical Center University Hospital, Amsterdam, the Netherland
Prostate cancer (PCa) is the second-leading cause of cancer death in men; however, reliable tools for detection and localization are still lacking. Dynamic Contrast Enhanced UltraSound (DCE-US) is a diagnostic tool that is suitable for analysis of vascularization, by imaging an intravenously injected microbubble bolus. The localization of angiogenic vascularization associated with the development of tumors is of particular interest. Recently, methods for the analysis of the bolus convective dispersion process have shown promise to localize angiogenesis. However, independent estimation of dispersion was not possible due to the ambiguity between convection and dispersion. Therefore, in this study we propose a new method that considers the vascular network as a dynamic linear system, whose impulse response can be locally identified. To this end, model-based parameter estimation is employed, that permits extraction of the apparent dispersion coefficient (D), velocity (v), and Péclet number (Pe) of the system. Clinical evaluation using data recorded from 25 patients shows that the proposed method can be applied effectively to DCE-US, and is able to locally characterize the hemodynamics, yielding promising results (receiver-operating-characteristic curve area of 0.84) for prostate cancer localization.
 
Medical image analysis. 2016 Oct 01 [Epub ahead of print]
 
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DotMed
HealthCareBusiness Daily News
Oct 7, 2016
 
GE ultrasound contrast agent Optison gets FDA OK for label change
by Thomas Dworetzky , Contributing Reporter
 
The FDA has approved a label change that allows GE Healthcare's Optison ultrasound contrast agent to be used in a larger range of cases. Specifically, it downgrades its use in patients with cardiac shunts and for administration by intra-arterial injection from a contraindication to a warning and precaution.
 
Prior to this labeling shift, to use the agent, perflutren protein-Type A microspheres injectable suspension, in suspected cardiac shunt populations, an agitated saline procedure was needed first.
 
The change makes Optison the first contrast agent for use in the U.S. to be so labelled, GE said in a statement.
 
The change has brought positive responses from a number of health care professionals, including Dr. Sharon L. Mulvagh, who is professor of medicine, director of the Women's Heart Clinic and preventive cardiology consultant in cardiovascular diseases at the Mayo Clinic and Mayo Clinic College of Medicine, GE noted.
 
“This label change will allow more patients access to a diagnostic imaging tool that has established safety and efficacy. The FDA’s decision to remove this contraindication is supported by a body of data from studies demonstrating safety and clinical benefits of all ultrasound contrast agents in patients with cardiovascular diseases,” said Mulvagh.
 
Mulvagh called the label change “an important step forward in eliminating barriers to ultrasound contrast use and delivering quality diagnostic care of value to our patients.”
 
Cardiac shunts are quite common and pose a challenge to clinicians. “Up to one-third of our patients have known or suspected cardiac shunts and, thanks to this important FDA decision, they, too, will now have access to ultrasound contrast agents, which offer an inexpensive and radiation-free option for diagnostic imaging,” noted Dr. Steven Feinstein, co-president of the International Contrast Ultrasound Society.
 
The decision came about thanks to “the overwhelming weight of evidence from clinical trials," noted Dr. Jonathan Lindner, M. Lowell Edwards Professor of Cardiology at the Knight Cardiovascular Center, Oregon Health & Science University.
 
He added that “most practitioners in the field of echocardiography already realize the benefits of using contrast agents and understand their capacity to improve diagnostic accuracy, improve outcomes, and streamline care. However, a major obstacle to widespread use has been lack of consensus and confusion regarding how far one needs to go to exclude shunts, no matter how small.”
 
The clinical advantage of appropriate use of the contrast agent was highlighted by the Head of Global Medical Services at GE Healthcare, Mark Hibberd, who added that Optison use will expand the imaging options and facilitate the care of “the clinically important group of patients who have suboptimal echocardiograms, and a need for left ventricular opacification and delineation of LV borders.”
 
The contrast market is set to surpass $6 billion by 2022, according to GlobalData research announced in April. The market was “just over $4.3 billion in 2015,” giving a compound annual growth rate of 4.9 percent.

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