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2008- Prenatal diagnosis


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State of the art of the 2008 technologies.

State of the art of the 2008 technologies.

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  • Los avances tecnológicos acercan la Anatomía Patológica a la US y a la Telemedicina.
    España debe estar presentes en esta innovación.
    Nanotechnology is based on the concept of tiny, self-replicating robots.
    The Utility Fog is a very simple extension of the idea: Suppose, instead of building the object you want atom by atom , the tiny robots linked their arms together to form a solid mass in the shape of the object you wanted? Then, when you got tired of that avant-garde coffeetable, the robots could simply shift around a little and you'd have an elegant Queen Anne piece instead.
    Here's a short list of the powers you'd have or appear to have if embedded in fog:
    Creation--causing objects to appear and disappear on command.
    Levitation--causing objects to hover and fly around.
    Manipulation--causing forces (squeezing, hitting, pulling) on objects (real ones) at a distance.
    Teleportation--nearly any combination of telepresence and virtual reality between fog-filled locations
    Utility Fog: The Stuff that Dreams Are Made Of By J. Storrs Hall. He discusses the technical details and feasibility of how a swarm of nanobots ("Foglets") that can take the shape of virtually anything. Also covered are some of the possibilities. "Imagine a microscopic robot. It has a body about the size of a human cell and 12 arms sticking out in all directions. A bucketfull of such robots might form a 'robot crystal' by linking their arms up into a lattice structure. Now take a room, with people, furniture, and other objects in it -- it's still mostly empty air. Fill the air completely full of robots. The robots are called Foglets and the substance they form is Utility Fog, which may have many useful medical applications. And when a number of utility foglets hold hands with their neighbors, they form a reconfigurable array of 'smart matter.'" Dr. J. Storrs Hall Research Fellow of the Institute for Molecular Manufacturing.
    Royal Philips Electronics is not only providing time-lapsed images of the baby in the mother's womb, but is developing an environment in which you can enjoy this experience. The space is intended to emulate that of a spa and will allow you to view images of your baby on a bubble-like screen.
    A 4-D time-lapse ultrasound image like this may elicit warm emotions as parents distinguish their unborn baby's facial features and fingers for the first time, but the same cannot usually be said about the clinical environment in which such images are created.
  • The LUMA™ Cervical Imaging System shines a light on the cervix and analyzes how different areas of the cervix respond to this light. The LUMA System assigns a score to tiny areas of the cervix and produces a color map that helps the doctor decide where to biopsy. The colors and patterns on the map help the doctor distinguish between healthy tissue, potentially diseased tissue, and areas that cannot be interpreted (e.g. tissue at the edge of the screen).
    We have demonstrated the multiscale imaging capability of PAM in vivo with optical absorption contrast (see Figure 1). Our initial 50MHz photoacoustic microscope probes to a depth of 3mm—filling the penetration void of ballistic imaging—at 15μm in axial resolution and 45μm in lateral resolution: see Figure 1(b).
    We have also been able to scale the spatial resolution down to 5μm by focusing a light beam to less than the depth of one optical transport mean free path. This resolution allows in vivo imaging of capillaries, which are the smallest blood vessels: see Figure 1(a).2 The ultimate lateral resolution is optically diffraction limited, potentially yielding submicron resolution.
    We have also scaled the penetration limit up to centimeters, extending photoacoustic microscopy to macroscopy. For example, by employing a 5MHz ultrasonic transducer and an 804nm light source, we were able to increase the penetration to 3cm: see Figure 1(c).4
    K. Maslov, H. F. Zhang, S. Hu, L. V. Wang, Optical-resolution photoacoustic microscopy for in vivo imaging of single capillaries, Opt. Lett. 33, pp. 929-931, 2008.doi:10.1364/OL.33.000929
    3. H. F. Zhang, K. Maslov, G. Stoica, L. V. Wang, Functional photoacoustic microscopy for high-resolution and noninvasive in vivo imaging, Nat. Biotechnol. 24, pp. 848-851, 2006.doi:10.1038/nbt1220
    4. K. Song, L. V. Wang, Deep reflection-mode photoacoustic imaging of biological tissue, J. Biomed. Opt. 12, pp. 060503, 2007.doi:10.1117/1.2818045
  • OCT delivers high resolution because it is based on light, rather than sound or radio frequency
    OCT, an interferometric technique, is able to penetrate significantly deeper into the scattering medium, for example ~3× deeper than its nearest competitor, Confocal microscopy.
    OCT is based on low-coherence interferometry.[8][9][10] In conventional interferometry with long coherence length (laser interferometry), interference of light occurs over a distance of meters. In OCT, this interference is shortened to a distance of micrometres, thanks to the use of broadband light sources (sources that can emit light over a broad range of frequencies). Light with broad bandwidths can be generated by using superluminescent diodes (superbright LEDs) or lasers with extremely short pulses (femtosecond lasers). White light is also a broadband source with lower powers.
    Depending on the use of high-brightness and wide-spectrum light sources such as superluminescent diodes or ultrashort pulse lasers, OCT has achieved sub-micrometre resolution (with very wide-spectrum sources emitting over a ~100 nm wavelength range).
    OCT delivers high resolution because it is based on light, rather than sound or radio frequency. An optical beam is directed at the tissue, and a small portion of this light that reflects from sub-surface features is collected. Note that most light is not reflected but, rather, scatters. The scattered light has lost its original direction and does not contribute to forming an image but rather contributes to glare. The glare of scattered light causes optically scattering materials (e.g., biological tissue, candle wax, or certain plastics) to appear opaque or translucent even while they do not strongly absorb light (as can be ascertained through a simple experiment — e.g., shining a red laser pointer through one's finger). Using the OCT technique, scattered light can be filtered out, completely removing the glare. Even the very tiny proportion of reflected light that is not scattered can then be detected and used to form the image in, e.g., a scanning OCT system employing a microscope.
    The physics principle allowing the filtering of scattered light is optical coherence. Only the reflected (non-scattered) light is coherent (i.e., retains the optical phase that causes light rays to propagate in one or another direction). In the OCT instrument, an optical interferometer is used in such a manner as to detect only coherent light.
  • <number>
    Her ses det mobile system i klinikken på Onkologisk Afdeling i Lund.
    Og det her er den håndholdte probe.
  • Gloucestershire Royal Hospital and University College London Hospital (UCLH) are to trial MDL’s Optical Coherence Tomography (OCT) scanner for research into rapid in-vivo identification of cancers affecting the cervix, oesophagus, skin, lung and other organs.
    ‘Optical Coherence Tomography’ (OCT) to detect non-scattered light from a scanned Near-IR laser, from up to 2 mm deep into translucent or semi-opaque material. Subsequent image processing of the OCT signal enables real-time display of the sub-surface image to the user.
    Images 6 mm wide x 2 mm deep are provided at an optical resolution < 10 μm.
  • Transcript

    • 1. DiagnosticoDiagnostico perinatalperinatal yy TELEMEDICINATELEMEDICINA Prof.Dr.O.Ferrer-RocaProf.Dr.O.Ferrer-Roca UNESCO ChairUNESCO Chair TelemedicineTelemedicine Congreso Nacional AEDPCongreso Nacional AEDP 6-7 Nov 20086-7 Nov 2008 Chair of Pathology Transforming Healthcare through Technology
    • 2. OFR2008 2 Computer evolutionComputer evolution  Moore’s LawMoore’s Law  Bell’s Corollary on Computer Class FormationBell’s Corollary on Computer Class Formation UMPC=UltramobilePersonalcomputers SPOT=SmartPersonalobjecttechnology Nanosensor sprays El viaje fantastico 2004 Glucowatch Foglet 5μ Creation Levitation Manipulation Teleportation Hitachi 50μ RFID TINYcomputers
    • 3. OFR2008 3 Bell´s lawBell´s law toto CyberspacCyberspac ee  New computer classesNew computer classes require new platforms,require new platforms, networks, and cyberization.networks, and cyberization.  New computer platformsNew computer platforms based on chipbased on chip density evolutiondensity evolution  NewNew apps and contentapps and content around each new classaround each new class  Each classEach class becomes a verticallybecomes a vertically disintegrateddisintegrated industry based onindustry based on hardware andhardware and software standardssoftware standards ,, after itafter it FLAILSFLAILS around 5-10 YEARSaround 5-10 YEARS 1999 2006 2000 veterinaria
    • 4. OFR2008 4 Imagen medicaImagen medica  FonendoFonendo  Ultrasonografo portatil (con TM.)Ultrasonografo portatil (con TM.) ZONARE Medical Systems- Z one ultra system Siemens-Acuson P50
    • 5. OFR2008 5 Siemens-Acuson P10Siemens-Acuson P10 20082008  HAND HELDHAND HELD
    • 6. OFR2008 6 Phot0BabyPhot0Baby Customizes Ultrasound VideosCustomizes Ultrasound Videos  NursingNursing management &management & something else…something else…
    • 7. OFR2008 7 Royal Philips ElectronicsRoyal Philips Electronics 4-D time-lapse ultrasound image4-D time-lapse ultrasound image  time-lapsed imagestime-lapsed images  space is intended to emulate that of a is intended to emulate that of a spa.  view images of your baby on a bubble-like screenview images of your baby on a bubble-like screen
    • 8. OFR2008 8 VIRTUAL SONOGRAPHYVIRTUAL SONOGRAPHY 20002000  Ultrasound in Obs & GynecologyUltrasound in Obs & Gynecology 2000 16:102,.16:102,. Ferrer-Roca et al.Ferrer-Roca et al. Three dimensional ultrasound reconstructionThree dimensional ultrasound reconstruction and telemedicine. Image analysis.and telemedicine. Image analysis.  J Med Internet ResJ Med Internet Res 20012001, June 22; 3 (2): e21., June 22; 3 (2): e21. Ferrer-Roca et al.Ferrer-Roca et al. Virtual Sonography through the Internet:Virtual Sonography through the Internet: Volume Compression IssueVolume Compression Issue http:// =1761897=1761897  J Perinat MedJ Perinat Med ((20062006) vol 34 :123-129 .) vol 34 :123-129 . Ferrer-Roca et al.Ferrer-Roca et al. Tele-Virtual Sonography.Tele-Virtual Sonography.
    • 9. OFR2008 9 Tele-Virtual Sonography  J Perinat MedJ Perinat Med 34 (34 (20062006) 123-129 . Ferrer-Roca et al.) 123-129 . Ferrer-Roca et al. Receiver Operating Characteristic (ROC) Plot 0.0 0.2 0.4 0.6 0.8 1.0 False Alarm Rate 0.0 0.2 0.4 0.6 0.8 1.0 HitRate Respuesta diagnostica con Ecografia local=66casos 12meses Receiver Operating Characteristic (ROC) Plot 0.0 0.2 0.4 0.6 0.8 1.0 False Alarm Rate 0.0 0.2 0.4 0.6 0.8 1.0 HitRate Respuesta a distancia con TeleInvivo 66 casos-12meses Diagnostic interobserver variability, local versus distant, was low since the kappa statistics is high (k=0.7);
    • 10. OFR2008 10 New image modalitiesNew image modalities  CT  US  MRI  OCT  CMicro  Hybrid
    • 11. OFR2008 11 3x Image modalities-SSVS 2005 Areas identified by pathologist / technician 26Mb 16Mb 40x 250x TEXCAN-II ® Ferrer-Roca SSVS 2005© Ferrer-Roca Low pow er M O  3x SUPER-RESOLUTION
    • 12. OFR2008 12 New ICT-toolsNew ICT-tools Health-GRID (2008)Health-GRID (2008)  GRID TECHNOLOGY IN TELEPATHOLOGY AND PERSONALIZEDGRID TECHNOLOGY IN TELEPATHOLOGY AND PERSONALIZED TREATMENTTREATMENT Ferrer-Roca OFerrer-Roca O . et al (2008). et al (2008) In: Grid Technologies for eHealth: Applications for Telemedicine Services & Delivery Editor: Dr. Ekaterina Kldiashvili. Georgian Telemedicine Union, Georgia IGI Global Publ. Philadelphia. USA Text Mining Literature Based Discovery (LBD) technique that use annotations and data in existing biomedical sources to discover associations. Image Mining ISO 19115/19139 standard on image metadata ontologies, MPEG-7 (MPEG Query Format-MPQF ISO/IEC 15938-12 ), MPEG-21 or ISO 21000-14, ISO 24800-3 for JPEG query search ISO/IEC 15444-2 for JPX metadata set DICOM (Q/R SCP query-retrieve service class ) KNOWLEDGE DISCOVERY
    • 13. OFR2008 13 TeleTele●●USUS  SoloSolo●●DPDP  WirelessWireless  Hand-held portableHand-held portable  Virtual sonographyVirtual sonography  Super-resolution imagesSuper-resolution images  New image modalitiesNew image modalities  Ultra-resolutionUltra-resolution  Personalized medicinePersonalized medicine  LBD-Image searchLBD-Image search  “solo-perinatology”“solo-perinatology” INNOVATIONS
    • 14. OFR2008 14 LUMA cervical imagingLUMA cervical imaging
    • 15. OFR2008 15 Image mergingImage merging  LOGIQ® E9LOGIQ® E9 new image technology &new image technology & real-time capabilityreal-time capability to mergeto merge an ongoingan ongoing ultrasound exam withultrasound exam with previously acquired CT,previously acquired CT, MR or US images.MR or US images.
    • 16. OFR2008 16 Siemens- ACUSON P10Siemens- ACUSON P10 Forthcomming Innov. ARFI (Acoustic Radiation Forced Impulse) imaging & new silicon US-technology Precise semiconductor production that realizes isotropic 3D and 4D ultrasound imaging. Dynamic TCE technology Amnioscopic Rendering Fetal Heart STIC (Spatio-Temporal Image Correlation) RF images HD (high density) transducer technology
    • 17. OFR2008 17 Photoacoustic microscopyPhotoacoustic microscopy at super depthsat super depths 3D tomographic photoacoustic microscopy (PAM)3D tomographic photoacoustic microscopy (PAM) • LightLight && ultrasoundultrasound  hybrid technologyhybrid technology  HIGHHIGH RESOLUTION IMAGING SUPER-DEPTH image.RESOLUTION IMAGING SUPER-DEPTH image. •1.1. Short-pulsed laserShort-pulsed laser  light absorbedlight absorbed  causes ancauses an increase in pressure viaincrease in pressure via thermoelastic expansionthermoelastic expansion.. •2. The increased pressure propagates through the tissue2. The increased pressure propagates through the tissue as an ultrasonic wave, known as aas an ultrasonic wave, known as a photoacoustic wavephotoacoustic wave,, •3. The wave is detected by an3. The wave is detected by an ultrasonic transducerultrasonic transducer thatthat produces electrical signals.produces electrical signals. •4. The signals are then4. The signals are then amplified, digitizedamplified, digitized, and, and transferred to a computer, where an image is formed.transferred to a computer, where an image is formed. PAMPAM  optical irradiation, ultrasonicoptical irradiation, ultrasonic detection, and image formationdetection, and image formation 5MHz US & 804 nm light  3cm depth
    • 18. OFR2008 18 OPTICAL COHERENCEOPTICAL COHERENCE TOMOGRAPHYTOMOGRAPHY LLimited to imaging 1 to 2 mm below the surface in biological tissueimited to imaging 1 to 2 mm below the surface in biological tissue  OCTOCT echo techniqueecho technique similarsimilar to UltraSound image Depending on high-brightness and wide-spectrum light sources such as superluminescent diodes or ultrashort pulse lasers, OCT has achieved sub- micrometre resolution (with very wide-spectrum sources emitting over a ~100 nm wavelength range). Resolution : EQUIVALENT TO LOW POWER MICROSCOPE. OCT  high resolution  based on light Optical Ultrasound: imaging reflections from tissue to provide cross-sectional images.
    • 19. OFR2008 19 OCT-ScannersOCT-Scanners
    • 20. OFR2008 20 OCT & MicroscopyOCT & Microscopy  Fiberoptic OCT systemFiberoptic OCT system  OCT endoscopyOCT endoscopy OCT MO
    • 21. OFR2008 21 OCT-Optical biopsyOCT-Optical biopsy
    • 22. OFR2008 22 OCT-ColposcopeOCT-Colposcope  Resolucion transversa 20 micrasResolucion transversa 20 micras Zeiss
    • 23. OFR2008 23 High Speed OCTHigh Speed OCT colposcopecolposcope
    • 24. OFR2008 24 Ultra-High resolution OCTUltra-High resolution OCT CYTOLOGIST
    • 25. OFR2008 25 Ultra-High & spectroscopicUltra-High & spectroscopic OCTOCT  1x3 micras1x3 micras100 micras UH-resolution OCT Spectroscopic OCT- melanocytes Red
    • 26. OFR2008 26 OCT Microscope - EX1301OCT Microscope - EX1301  Gloucestershire Royal Hospital and University College London Hospital (UCLH) are to trial MDL’sGloucestershire Royal Hospital and University College London Hospital (UCLH) are to trial MDL’s Optical Coherence Tomography (OCT) scanner for research into rapid in-vivo identification ofOptical Coherence Tomography (OCT) scanner for research into rapid in-vivo identification of cancers affecting the cervix, oesophagus, skin, lung and other organs.cancers affecting the cervix, oesophagus, skin, lung and other organs.
    • 27. OFR2008 27 OCT & EmbrionOCT & Embrion developmentdevelopment  Animal development in vivoAnimal development in vivo No hay razón, mas que los plazos éticos y de autorización para no hacerlo en humanos
    • 28. OFR2008 28 MEDICINE AT DISTANCEMEDICINE AT DISTANCE  StandardizationStandardization & interoperability& interoperability  Quality assuranceQuality assurance  Risk management & consumer/user confidenceRisk management & consumer/user confidence  Plug & playPlug & play  easy to use / easy to integrateeasy to use / easy to integrate  Portability & Mobility.Portability & Mobility. TECHNICALTECHNICAL IMPLEMENTATIONIMPLEMENTATION ee--medicine,medicine, tt--medicine,medicine, pp--medicine.medicine. LICENCING
    • 29. OFR2008 29 AMI@medicine inAMI@medicine in NeonatologyNeonatology Alimentación con el roce del tejido
    • 30. OFR2008 30 SUMMARYSUMMARY  La TM debe realizarse con criterio de calidad.La TM debe realizarse con criterio de calidad.  La TM debe implantarse en PERINATOLOGIA.La TM debe implantarse en PERINATOLOGIA.  La SONOGRAFIA VIRTUAL es de granLa SONOGRAFIA VIRTUAL es de gran utilidad.utilidad.  Las NUEVAS MODALIDADES imagen laLas NUEVAS MODALIDADES imagen la acercan a la Anatomía Patológica.acercan a la Anatomía Patológica.
    • 31. OFR2008 31 THANK YOU FOR YOURTHANK YOU FOR YOUR ATTENTIONATTENTION Prof.Dr.O.Ferrer-RocaProf.Dr.O.Ferrer-Roca UNESCO Chair TelemedicineUNESCO Chair Telemedicine  ““Who's who in the World”,Who's who in the World”, 1996-act1996-act  ““Who's who in Medicine and Healthcare”, 1999-act.Who's who in Medicine and Healthcare”, 1999-act.  ““Who's who in Technology”,Who's who in Technology”, 1999-act.1999-act.  ““Who’s who of Professionals”,Who’s who of Professionals”, 2000-act.2000-act.  ““Who’s who in Science and Engineering”, 2001-Who’s who in Science and Engineering”, 2001- act.act. htttp://