GE Healthcare CT Clarity magazine 2011


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GE Healthcare CT Clarity magazine 2011

  1. 1. GE HealthcareclarityCT § Veo Ultra Low Dose – p. 32THE MAGAzINE oF CT • JuNE 2011Spectral CT: A Brave CTA Changing Veo: A New BreakthroughNew World of Quantitative, Patient Management is Re-writing the RulesFunctional Imaging in the ED of Low-dose CT ImagingPage 11 Page 26 Page 32 imagination at work § Veo is 510(k) pending at FDA. Not commercially available in the united States.
  2. 2. TA B L E o F CoNTENTS Case Study: CT Perfusion 4D Imaging in Stroke Assessment page 48 Clinical Value: Making Reliable Low-dose GE Healthcare News: First-time CT a Clinical Reality CT users Embrace Brivo CT325§ page 20 page 10 GE Healthcare News Clinical Value Welcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 Spectral CT: A Brave New World of Quantitative, Functional Imaging . . . . . . . . . . . . . . . . . . 11 - 19 South America Embraces the Latest GE CT Technologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 Making Reliable Low-dose CT a Clinical Reality . . . . . . . . 20 - 24 New Tools to Analyze Vessel Lumen, Diseased Tissue . . . . . . .6 CTA Changing Patient Management in the ED . . . . . . . . . . . . . . . . . . . . . . . 26 - 29 Quantitative Assessment of the Lung . . . . . . . . . . . . . . . . . . . . . . .6 Kenya Hospital Extends unravelling the Mystery Behind Mummies . . . . . . . . . . . . . . . . . .7 Quality CT Imaging to More Residents . . . . . . . . . . . . . . . . 30 - 31 GSI Shines at Conferences, Journal Competition . . . . . . . . . . . .8 Veo‡: A New Breakthrough is Re-writing optima CT660‡ the Rules of Low-dose CT Imaging . . . . . . . . . . . . . . . . . . . 32 - 37 Reaches Milestones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 Reaching New Heights First-time CT users Embrace Brivo CT325 . . . . . . . . . . . . . . . . . 10 in CT Cardiac Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 - 39 Eco, Patient, and Physician Friendly: Advanced Low-dose Imaging Without Compromise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 - 41 Make Every Study Exceptional . . . . . . . . . . . . . . . . . . . . . . . 42 - 43 Publications Team: GE Contributors: Kelley Knutson & Jodi Young Andrew Ackerman Morris Buliva CT Clarity Editors CT Marketing Manager Account Manager, East Africa CT Education Managers Olivier Adda Roger Cepeda John Allenstein CT Super Premium Strategic Product Associate General Counsel, Diagnostic Imaging Marketing Communications Manager Manager, Europe, Middle East & Africa Lawrence Chia CT and Advantage Workstation Dr. Karthik Anantharaman CT Modality Manager, Southeast Asia, CT Marketing Manager, South Asia Australia & New zealand Mary Beth Massat Christophe Argaud DeAnn Haas Writer/Editorial Consultant CT Advanced Applications Manager, CT Marketing Manager, Leadership Nilesh Shah Europe, Middle East & Africa Segment, Americas Chief Marketing officer, CT Paul Ayestaran Takuya Hiramoto J. Eric Stahre Advanced Applications Specialist, Product Marketing Specialist, Japan General Manager, Global Premium CT Europe, Middle East & Africa John Jaeckle Chelsea Beeler Regulatory Affairs Manager Integré Communications Manager Gina Larkin Design/Production Chuck Bisordi CT Marketing Manager Jennifer Coppersmith CT Product Development Specialist Huayang Liu Design/Production Consultant Valerie Brissart China HDCT Product Leader CT Marketing Director, Europe, Pascal Lucien Middle East & Africa CT Modality Manager, Africa2 A GE Healthcare CT publication • June 2011
  3. 3. TA B L E o F C o N T E N T S Technical Innovation: The Model-Based Paradigm: Beyond the Scan: A New Frontier in Image Working Together Towards Reconstruction the Sub-mSv CT Exam page 63 page 69 Case Study Beyond the ScanHigh Quality, Reduced Dose Imaging Techniques to Lower CT Dose . . . . . . . . . . . . . . . . . . . . . . . . 66 - 68in the Comprehensive Evaluation Working Together Towardsof Potential Kidney Donors . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 - 45 the Sub-mSv CT Exam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 - 71Characterization CT Clinical Education in the uS,of Renal Stones using GSI. . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 - 47 Europe, Middle East, and Africa . . . . . . . . . . . . . . . . . . . . . . 72 - 73CT Perfusion 4D in Stroke Assessment . . . . . . . . . . . . . . . . 48 - 49Low-dose CT Imagingof CPAM for Surgical Planning . . . . . . . . . . . . . . . . . . . . . . . . 50 - 52 Technical InnovationSystem Design Combines High Performancewith Patient, Earth Friendliness . . . . . . . . . . . . . . . . . . . . . . 53 - 55one Seamless Workflow Environment . . . . . . . . . . . . . . . . 56 - 58 To receive future issues of CT Clarity,The Importance of Spatial Resolution please subscribe at: High-quality Cardiac CT Exams . . . . . . . . . . . . . . . . . . . 59 - 62The Model-based Paradigm: A New Frontier * Discovery, optima, Brivo, ASiR, Veo, LightSpeed, BrightSpeed,in Image Reconstruction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 - 65 Gemstone, SnapShot, SmartmA, AutomA, Performix, VCAR, Volara, VolumeShuttle, Dexus, Centricity, CardIQ, and AppsLinq are trademarks of General Electric Company. § Brivo CT325 is not for sale in the united States. Not clearedAndrew Menden Karen Procknow by the uS FDA.Regulatory Affairs Leader CT Product Development Specialist ‡ optima CT660 and Veo are 510(k) pending at FDA.Thierry Modica Linda Pucek Not commercially available in the united States.CT-AW Advanced Application Specialist, Africa CT Segment Marketing Manager, © 2011 General Electric Company, doing business as GE Healthcare.Daniel Morris oncology, Americas All rights reserved. The copyright, trademarks, trade names andCT Global Marketing Manager Dario Salvadori other intellectual property rights subsisting in or used in connectionEnrique Garcia-Muñiz CT Performance & Value Strategic Product with and related to this publication are the property of GE Healthcare Manager, Europe, Middle East & Africa unless otherwise specified. Reproduction in any form is forbiddenCT Marketing Manager, Latin America without prior written permission from GE Healthcare.Christoph Obermeier Saad Sirohey, PhD LIMITATION OF LIABILITY: The information in this magazine isCT Clinical Education Business Manager, Global Product Manager, intended as a general presentation of the content included herein.Europe, Middle East & Africa CT Advanced Applications While every effort is made by the publishers and editorial board Stephen Slavens to see that no inaccurate or misleading data, opinion or statementsTracey Ortiz occur, GE cannot accept responsibility for the completeness,Regulatory Affairs Leader Regulatory Affairs Director, AW currency or accuracy of the information supplied or for any opinionKonstantin Osadchiy, MD, PhD Cristian Toader expressed. Nothing in this magazine should be used to diagnoseCT Advanced Applications Specialist, Russia & CIS CT Premium Strategic Product Manager, or treat any disease or condition. Readers are advised to consult Europe, Middle East & Africa a healthcare professional with any questions. Products mentionedHelen Peng in the magazine may be subject to government regulation andRegulatory Affairs Leader Wayne Zhang may not be available in all locations. Nothing in this magazine Marketing Product Manager constitutes an offer to sell any product or service. A GE Healthcare CT publication • June 2011 3
  4. 4. Welcome Steve Gray, Vice President and General Manager, Computed Tomography, GE Healthcare At GE Healthcare CT, we believe that great care happens For over three decades, GE has made a commitment to by design. our organization makes decisions regarding developing technologies that lower radiation dose. our CT product development with one purpose in mind: to help long-standing vision is clear—to be a leader in patient-centric healthcare providers deliver the best patient care. You, our solutions, to design systems that deliver high-performance customers, have spoken and we heard your voices loud imaging, and to continue developing innovations that drive and clear. even lower dose. You told us you want to deliver high image quality for But how low can we go? At GE Healthcare, our goal is the diagnosis at ever lower doses for all of your patients who 1 mSv study across all pathologies, anatomies, and studies. need a CT. We heard that you want to expand the diagnostic Lowering dose is a core commitment in our effort to deliver capabilities of CT—to let you know more about the pathology great care by design. In past issues of CT Clarity, you’ve read you are viewing to aid you in making precise, confident how dose-reduction technologies like ASiR* deliver high clinical decisions. You want a CT system with high spatial image quality while lowering dose. Now, in this issue, we resolution to deliver excellent image quality that drives present our latest dose-lowering advancement, Veo§. advanced applications and productivity. Veo is our next generation dose-lowering technology. In this issue of CT Clarity, you can read how GE Healthcare Learn how several healthcare providers around the world is delivering solutions to address your clinical needs and have achieved remarkable breakthroughs in high-quality, to help you provide great care to your patients. impressively low-dose CT imaging with Veo (page 34). We believe this new technology will play a key role in moving on page 11, read how Gemstone* Spectral Imaging (GSI) us toward our goal of the 1 mSv study across all exams is opening up an exciting and promising new world for and will help you achieve your diagnostic needs at before CT imaging—where clinicians can obtain quantitative unheard of doses without any compromise in image quality. information on tissue characterization, reduce artifacts from In fact, you’ll learn that some clinicians actually experienced metal instrumentation, and enhance contrast material. an increase in image clarity while they reduce dose when In an article on spatial resolution (page 40), you can learn using Veo. Clearly, the rules of CT imaging have changed. how the high spatial resolution on the Discovery* CT750 HD Read on and you’ll understand why we at GE Healthcare improves cardiac CT imaging and why it is an important are so excited about the future of CT. This last decade consideration as you investigate solutions that improve was a phenomenal one—widespread adoption of the cardiac care at a lower dose. multi-detector CT was heralded as a major advancement We introduced three new systems that are designed with in medical imaging. At GE we’ll continue to pursue innovation great care to expand the reach of CT to patients throughout that drives a more confident diagnosis at the lowest dose the world. These include the optima* CT660§ system that is in the delivery of care—together with you, great care by ecomagination and healthymagination validated (page 42); design can impact healthcare across the world. the BrightSpeed* Elite that demonstrates our commitment Please read and enjoy. And as always, thanks for your to bring advanced applications and dose lowering technology continued support. across our product platforms (page 44); and the Brivo* CT325,‡ a system that extends modern CT technology to healthcare facilities so they can provide advanced medical imaging services to their patients—patients who may otherwise not have access to CT imaging (page 32). § Veo is 510(k) pending at FDA. Not commercially available for sale in the united States. Brivo CT325 is not for sale in the united States. Not cleared by the uS FDA. ‡4 A GE Healthcare CT publication • June 2011
  5. 5. ANNouNCEMENTS G E H E A LT H C A R E N E W SSouth America Embracesthe Latest GE CT TechnologiesAdvances in CT generate excitement Low-dose CT makes its mark in Argentinain Southern Brazil Innovative leadership. That’s how Dr. Sergio Julio Moguillansky,Powered by the first new CT scintillator material in two Director of Medicina XXI SA (Neuquen, Argentina) describesdecades, the Discovery* CT750 HD generates excellent, high GE Healthcare and its exclusive ASiR dose lowering technology.definition image quality. This capability inspired Carlos Jader “The concept of reducing dose whenever possible to achieveFeldman, MD, at SIDI – Medicina por Imagem (Porto Alegre, the appropriate diagnosis is inherent to our specialty,” he says.Brazil) to select the Discovery CT750 HD and become the “Thus, we consider every technological advance that allowssecond site in South America to acquire this system. us to reduce the dose a priority.”Anticipating tomorrow’s needs, Dr. Feldman saw the ability The hospital recently installed ASiR technology on its LightSpeed*to capture high definition images that characterize complex VCT and is experiencing dramatic low-dose results. While thelesions, such as coronary artery stenosis, as the most actual dose level is closely related to the type of exam and theimpressive benefit to his patients and practice. “I believe the expected results required for appropriate patient management,Discovery CT750 HD will allow me to accurately diagnose Dr. Moguillansky is excited to offer less dose to his patients whoischemic patients,” he says. With excellent image clarity and are becoming increasingly aware of CT radiation dose.spatial resolution, Dr. Feldman expects the system will allow “Patients are addressing the dose issue with our clinicians,for faster clinical decisions by clinicians. most notably the pediatricians,” he says. “With ASiR, weLocated in Brazil’s fourth largest metropolitan area with nearly can demonstrate our commitment to providing the properfour million inhabitants, SIDI and Dr. Feldman have long trusted diagnosis through the ALARA principle.”GE Healthcare’s technological leadership. While it was a natural At Medicina XXI SA, CT imaging volume averages 40 patientschoice to look to GE for the next generation in CT imaging, each day across a wide spectrum of indications—abdominal,Dr. Feldman saw the potential of Gemstone* Spectral Imaging thoracic, vascular, and neurological conditions. High-quality(GSI) to help him deliver a new level of care to his patients. and fast imaging capabilities are a primary objective at the“Today’s clinical path leads to anticipating etiology of diseases, facility, says Dr. Moguillansky. By offering substantial dose thus, it means earlier diagnostics and more accurate treatments,” reductions at a similar image quality, ASiR fulfills the facility he says. With GSI, HD, and ASiR* * all available on one system, requirements and helps alleviate concerns over dose. Dr. Feldman is thrilled at the potential to deliver a higher level “our expectations are very high,” adds Dr. Moguillansky, of exam accuracy while enhancing patient comfort. “I will be “and we are pleased to implement this technology due to the able to provide patients and referring physicians a confident increasing benefit that it will bring to our clinical practices CT diagnosis and broader range of exams,” he adds. and particularly, to our patients.” n “I will be able to provide patients and referring physicians a confident CT diagnosis and broader range of exams.”**In clinical practice, the use of ASiR may reduce CT patient dose depending on the – Dr. Carlos Feldman clinical task, patient size, anatomical location and clinical practice. A consultation with a radiologist and a physicist should be made to determine the appropriate dose to obtain diagnostic image quality for the particular clinical task. A GE Healthcare CT publication • June 2011 5
  6. 6. G E H E A LT H C A R E N E W S ANNouNCEMENTS New Tools to Analyze Vessel Lumen, Diseased Tissue CT imaging is changing the way clinicians diagnose cardiac customizable color mapping to improve visualization of plaque disease. Yet, the large volume of data generated by today’s pathology for a better understanding of the severity of disease. advanced systems can impede workflow if clinicians don’t The GE exclusive relative perfusion tools use sophisticated have the right tools to process the information. As an integral segmentation techniques to color code the myocardial tissue. part of Dexus*, CardIQ* Xpress Reveal, streamlines your Hypodense lesions are displayed to better visualize ischemic workflow so that exams of the heart and coronary anatomy heart disease to aid in treatment planning. Plus, the new hybrid are ready to review the instant you’re ready to read. display view combines the coronary arteries and perfusion Two enhanced tools are designed to help clinicians improve their map to correlate the vessels to diseased tissue. diagnosis. The new PlaqID plaque analysis tool allows clinicians CT is an excellent non-invasive alternative for diagnosing to visualize both calcified and non-calcified plaque to determine coronary artery disease. using CardIQ Xpress Reveal speeds the amount of atherosclerosis. This new tool also offers assessment of the patient’s cardiac disease state by delivering more information in a simpler, faster, smarter way. n Coronary tree Cardiac perfusion PlaqID Quantitative Assessment of the Lung Now available, Thoracic VCAR* provides the physician with Together these capabilities provide an integrated application a set of quantitative tools that will aid the physician in the for a comprehensive evaluation of a lung CT image. The analysis assessment of thoracic disease diagnosis and management. tools are married to an easy-to-use reporting capability that The software provides automatic segmentation of the lungs automatically captures and airway tree, as well as tracking of the airway tree. The the analysis results. The software will also provide the quantification of Hounsfield units end result is a clear and and display by color the thresholds within a segmented region. concise clinical report that is generated during Key features include: the reading process and • Automated segmentation of right and left lung airways— specifically designed for ease of use assists in quantification of lungs and airways; the communication of • one touch 3D airway tracking with automated vital medical information measurements—simple user interface aids in analysis to referring clinicians and review; and patients. n • Lung Lobe segmentation—intuitive interactive lobe Parenchyma analysis segmentation that allow for reporting of quantitative measurements by lobes; and • Parenchyma analysis—parenchyma protocol for generating quantitative measurements displayed as percentage/ liters of volumes of abnormal density. Lung lobe segmentation Volume rendering segmented lobes6 A GE Healthcare CT publication • June 2011 with segmented trachea
  7. 7. ANNouNCEMENTS G E H E A LT H C A R E N E W Sunravelling the MysteryBehind MummiesFinding out the details underneath the bandages of the Then again in 2006, another scan using better technologymummies from the Milwaukee Public Museum is what Carter revealed a silver dollar-sized hole in his skull, leadingLupton, PhD, Curator of Ancient History, Department Head the anthropologists to conclude he had undergoneat the museum, hopes to do thanks to the most advanced a primitive form of brain surgery.CT technology by GE Healthcare, the Discovery* CT750 HD. To best help the museum unravel the mummy mystery,Three of the mummies from the museum collection were GE Healthcare provided a cutting-edge Discovery CT750 HDscanned in April, 2011 to find out more information about along with Gemstone* Spectral Imaging (GSI), whichtheir gender, age and causes of their death. offered high quality images and a dramatic levelIn collaboration with GE Healthcare, researchers of detail. GSI also allows researchers to distinguishfrom the Milwaukee Public Museum used one type of tissue from another in order to betterthe latest GE CT imaging technology understand the makeup of the mummies’ bodiesto look back through time and start and other material.unraveling details about how three Dr. Lupton and his research team used the highmummies—two from ancient resolution images from the CT scanner to learnEgypt and one from Peru—lived more about ancient medical skills and knowledge,and died. as well as create 3D holographic representationsThis isn’t the first time the of what the mummies would have lookedanthropologists have turned like when they were GE Healthcare for “We’ve been doing this for 25 years with GE.assistance, and as GE’s Every time we’ve come out, it’s a differentCT imaging technology has generation of technology, better imaging,improved, so too has their better information, better ways, and it’sknowledge of the mummies’ faster too,” Dr. Lupton added. nhistory. one of the Egyptianmummies, named Djed-Hor,was first scanned in 1986. An ancient Egyptian mummy is scanned.CT scan of a Peruvian mummy. A GE Healthcare CT publication • June 2011 7
  8. 8. G E H E A LT H C A R E N E W S ANNouNCEMENTS GSI Shines at Conferences, Journal Competition American Society of Spine Radiology “We found that the readers had improved sensitivity, specificity, At the American Society of Spine Radiology (ASSR) conference, and diagnostic confidence when using the material density Dual Energy Spectral CT of the Instrumented Spine: Tuned images with color and the attenuation curves compared to Monochromatic Imaging Improves Quality over Traditional 140 kVp or 70 keV images alone,” Dr. Ruhland says. “of Techniques won third place in the Mentor Award Program. clinical importance is that using the spectral CT data, the The authors, James M. Kessler, MD, MPH; J. Rios, MD, PhD; M. radiologists were able to accurately determine whether Ellestad; P. Pawha, MD; A. Doshi, MD; E.G. Stein, MD, PhD; the renal lesion was enhancing or non-enhancing, thereby and Lawrence N. Tanenbaum, MD, FACR, demonstrated avoiding unnecessary and costly additional tests.” how employing Gemstone* Spectral Imaging (GSI) in Dr. Ruhland acknowledges that while further study is needed, patients post-spinal fusion produced excellent image she is hopeful that this first place paper demonstrating quality with reduced spinal canal artifact and optimal the successful use of spectral CT to characterize renal hardware visualization. lesions will ultimately help reduce healthcare costs associated “Historically, quality imaging of the spine in patients post with working up indeterminate renal lesions seen with CT. hardware fusion remained fraught with prohibitive Also at SGR, the university of Alabama at Birmingham artifacts utilizing traditional polychromatic CT scanners,” earned the award for First Place Poster. Desiree E. Morgan, explains Dr. Kessler. MD, Vice Chair for Clinical Research, accepted the award The authors displayed examples of CT myelography for the poster, Dual Energy Spectral MDCT of the Pancreas: with and without the benefits of spectral imaging and Imaging Beyond Anatomy. demonstrated a markedly improved capacity for clear “The poster captures an exciting new area that deserves visualization of the central spinal canal and its contents, further exploration by demonstrating the large number of including the spinal cord and nerve roots. Dr. Kessler notes applications for spectral CT imaging,” says David N. Bolus, MD, that in many cases, spectral CT myelography differentiated Assistant Professor, a co-author. soft tissue in a similar manner to MRI allowing for optimal depiction of the nerve roots and adjacent soft Dr. Morgan agrees that spectral CT created excitement tissue structures. and “a groundswell such that I have not seen before at a clinical symposium. The images were clearly different than “This technique virtually eliminates the artifact,” he explains, traditional CT—my fellow gastrointestinal radiologists and “and the ability to generate the same high quality exam as genitourinary radiologists all wanted to learn more about this we would expect in non-instrumented patients opens up intriguing new technique.” a new opportunity for patient management in those who might otherwise have persistent chronic symptoms.” “The ability to capture material density,” Dr. Morgan continues, “and quantitatively differentiate things such as fat and iron Society of Gastrointestinal Radiology in the liver, for example, is quite remarkable.” GSI won two different awards at this year’s Abdominal Radiology Course meeting, a joint meeting of the Society of Gastrointestinal Radiology (SGR) and the Society of uroradiology (SuR). The first place paper from the SuR was awarded to Jessica Ruhland, MD; Amy Hara, MD; Alvin Silva, MD; Rishi Gosalia, MD; and Qing Wu, MD, of the Mayo Clinic Arizona for the Assessment of Renal Lesion Enhancement: Comparison of Single and Dual Energy CT. According to Dr. Ruhland, the study reported on the Drs. Morgan and Bolus stress that what is truly important evaluation of five image datasets by two radiologists blinded will be the future impact on patient care—and how to diagnosis: 140 kVp; 70 keV monochromatic; material radiologists, by utilizing spectral CT, can aid referring density (MD) water/iodine; MD iodine with color; and physicians in making patient management decisions. attenuation curves from 40 to 140 keV. Adds Dr. Bolus, “When our research helps propel further utilization of a technique, so that it is widely used throughout the medical community, then for us it truly becomes ‘groundbreaking’.”8 A GE Healthcare CT publication • June 2011
  9. 9. ANNouNCEMENTS G E H E A LT H C A R E N E W SChinese Journal of Radiology After the thorough evaluation, the committee selectedInitiated by renowned radiology opinion leaders and senior eleven papers—all using GE Healthcare’s GSI—for publicationeditors, the Chinese Journal of Radiology (CJR) held the in the Spectral CT Special Edition this past spring.Spectral CT Research Paper Competition in September, 2010. Professor Hong Gao, Editor-in-Chief of CJR, says, “CTThirty-four spectral CT research papers were submitted Spectral Imaging is an exciting new study area of radiology.covering in-vitro experiments, impact on image quality, From all of the 34 submitted research papers, we sawartifact reduction, tissue characterization, differentiated its fundamental impact on our CT practice and research.diagnosis in oncology, hemodynamic studies, and We look forward to more promising clinical applicationstherapy evaluation. and research in the future.” noptima CT660 Reaches Milestones GE Healthcare is pleased to announce the 100th optima* CT660§ Program, and Dr. Mohammad Alshaji, Director of the Medical will be delivered to olbia Hospital in Sardinia for the S. Department, and the Royal Commission Hospital team Raffaele Foundation. Since the global introduction of the to celebrate the installation of this new system. This new system in April, 2010 over 200 orders worldwide have system will deliver excellent CT imaging to the Al Jubail area been received. in the Eastern Province of the Kingdom of Saudi Arabia. of the 200-plus orders, nearly half of the sites are installed Inauguration symposium at St. Rembert Hospital and operational as of April, 2011. This high demand An inauguration symposium took place in Torhout, Belgium demonstrates that the optima CT660 is answering the at the St. Rembert Hospital—the first European site to clinical imaging needs of radiologists. receive the optima CT660 with ASiR and overlapped Reconstruction options. The overlapped Reconstruction feature enables 128 slices per axial rotation. The symposium included invited speakers on cardiac CT and dose reduction technologies, a live demonstration on post-processing applications, and a lecture comparing CT with conventional radiology. St. Rembert is a medium-sized hospital with a 250-bed capacity and offers healthcare services to a population of 50,000 in West Flanders. The CT system is being used for all protocols, including emergency, cardiovascular, and cardiac imaging, and current daily patient volumeRoyal Commission Hospital Team is approximately 40 patients.Royal Commission Hospital Geert Bibau, MD, Chief of the Radiology Department,GE Healthcare recently installed the first optima CT660 explained that among the reasons for choosingwith ASiR in the Middle East region. The local GE team joined optima CT660 with ASiR were the excellent post-processingMr. Abdul-Rahman Alhewar, Director of Health Service capabilities and dose reduction technologies. noptima CT660 is 510(k) pending at FDA. Not commercially available in the united States.§ A GE Healthcare CT publication • June 2011 9
  10. 10. G E H E A LT H C A R E N E W S ANNouNCEMENTS First-time CT users Embrace Brivo CT325 Across the world, healthcare providers who are first-time CT Just as the compact system fits new users’ needs, GE’s service system buyers are discovering they don’t have to compromise and support is designed to offer the same. The latest advances between value and performance. The Brivo* CT325§, a in service technology, such as remote diagnostics, help maximize GE Healthcare CT scanner developed and manufactured system uptime and resolve many service calls remotely. in China, achieves the balance of an attainable, reliable, and Maintenance and service elements coupled with comprehensive, capable CT scanner. flexible training solutions, enables each organization to meet its service and support needs. “This is reverse innovation at its best,” says Wayne zhang, Product Manager, GE Healthcare, China. “We’ve designed the Brivo CT325 “The images and the applications are excellent and reliable,” with advanced GE technologies and leading-edge features in an says zeng Xianming, MD, Director of the Radiology Department, ultra-compact, space-saving system that provides the efficiency Anhua Traditional Chinese Medicine Hospital, Hunan province. and resolution required for many types of routine CT procedures.” “With the speed of the system, we can image as many as 30 to 40 patients in one day without any overtime scanning. This has Brivo CT325 was created with the new user in mind—by reducing helped us provide better support to other departments the number of steps needed to position and release the patient, in the hospital.” the table design helps streamline CT exam workflow and increase throughput. The operating console combines both image Brivo CT325 combines simplicity with performance— acquisition and post-processing with advanced applications, incorporating CT perfusion, CT colonography, vessel analysis, simplifying management of multiple tasks from a single location. and advanced volume analysis including averaging, MIP, MinIP, and volume rendering. “The Brivo CT325 imaging capabilities fulfill the various clinical needs of the average user,” says Qui Jianxing, MD, PhD, Peking “Priced affordably for facilities that couldn’t previously afford university First Hospital and the clinical evaluation site for to implement CT, Brivo CT325 embraces GE’s healthymagination the system. “The system is very reliable, enabling us to scan initiative and increases access to CT imaging,” zhang adds. patients all day.” In fact, for 67% of the sites implementing Brivo CT325, this Reliable, high-quality imaging is assured with Auto mA to is the first CT system purchased. After a successful launch in improve signal-to-noise ratio and optimize dose; the bowtie China, Brivo CT325 was introduced in Asia-Pacific, India, Latin X-ray beam-shaping filters to maintain uniform X-ray at the America and Africa. Learn more how one facility in Kenya— detector, minimize surface dose, and reduce X-ray scatter; Jocham Hospital—is using the Brivo CT325 to better serve the beam-tracking system, which contributes to higher dose its patients (page 32). n efficiency by automatically measuring the position of the beam and adjusting the collimator using data transferred in real time; and, the high-absorption efficiency (98%) and stability of GE detectors for high image quality with optimized dose. A head exam on Brivo CT325 at Anhua Qingdao No. 5 People’s Hospital. Traditional Chinese Medicine Hospital. § Brivo CT325 is not for sale in the united States. Not cleared by the uS FDA.10 A GE Healthcare CT publication • June 2011
  11. 11. GEMSToNE SPECTRAL IMAGING CLINICAL VALuE Spectral CT: A Brave New World of Quantitative, Functional Imaging CT has long been considered an excellent method for viewing high-resolution images of human anatomy in a non-invasive manner. It has been used in conjunction with PET and MRI—devices that can image tissue and organ function—to bring together anatomic and morphologic information for a more precise patient diagnosis and treatment plan. While CT is “an excellent technique with good spatial and temporal resolution, the soft tissue contrast and ability to discriminate normal and pathological tissues is sometimes inferior to other imaging techniques,” says Valentin Sinitsyn, MD, PhD, Chief of the Radiology Department at the Federal Center of Medicine and Rehabilitation“GSI’s spectral (Moscow) and Professor and Chair of Radiology, School of Fundamental Medicine at Moscow State university. This limitation has led to the utilization of other functional Hu curve and imaging techniques in conjunction with CT imaging—which may result in additional studies and potentially higher healthcare costs. material-basis analysis However, CT is closing the gap between anatomical and alternative functional imaging provides us with thanks to advances in spectral CT and the introduction of Gemstone* Spectral Imaging information on material (GSI) on the Discovery* CT750 HD scanner. Today, GSI is beginning to change the way radiologists across the world utilize CT imaging. characterization and quantification—this is revolutionary.” – Prof. Xiao-Peng Zhang A GE Healthcare CT publication • June 2011 11
  12. 12. CLINICAL VALuE GEMSToNE SPECTRAL IMAGINGGemstone Spectral ImagingGemstone Spectral Imaging (GSI) is adual-energy scan mode that acquires “GSI is breaking down a barrier by bringing a new type of functional imaging to CT,”data of an object by rapidly switching explains Jean-Nicolas Dacher, MD, PhD, Professor of Radiology and Diagnostic Imagingbetween low kVp and high kVp energies and the Chief of the Department of Diagnostic Imaging at Rouen university Hospital,in less than half a millisecond. This (France). He routinely uses GSI, performing approximately 20 cases each week. “Plus,generates data with different attenuation with CT we have the advantage of a quick examination that can be more comfortablevalues based on the corresponding for the patient,” he adds. This is compared to traditional functional imaging studiesenergy levels. The result is a near-perfect, (MR, SPECT and PET) that can last a minimum of 20 minutes to one hour, an importantsimultaneous dual-energy acquisition consideration for very sick and elderly the full 50 cm scan field of view (SFoV)producing projection (raw) data at two After conducting more than 1,500 GSI scans and 20 pilot studies in the first threedifferent energy levels that has virtu- months of using GSI, Xiao-Peng zhang, MD, Professor and Chairman of Radiology,ally no misregistration. This enables raw Peking university Cancer Hospital and Institute (China), clearly sees its clinical reconstruction of dual-energy “We believe GSI will change the way that doctors practice and interpret CT,” he with the associated benefits of “GSI’s spectral Hu curve and material-basis analysis provide us with informationquantitative material decomposition on material characterization and quantification—this is revolutionary.”and beam-hardening reduction from Revolutionary is a statement echoed by Lawrence Tanenbaum, MD, FACR, Directormonochromatic energy synthesis. of MRI, CT, and outpatient/Advanced Development, Mt. Sinai School of Medicine (uSA).Projection-based reconstruction is used “Spectral CT offers potentially revolutionary information when compared to traditionalto process the data. Based on known polychromatic CT,” he says, “including the ability to reduce certain artifacts, suchattenuation curves, the process as streak and beam hardening from metal, enhance contrast resolution that willmathematically transforms low and high perhaps make iodine more or less conspicuous, or improve contrast resolutionkVp attenuation measurements into by alternating energy levels to differentiate two different tissues.”effective material density (MD) basis-pairimages. This is also known as material Tissue characterizationdecomposition. GSI produces theseMD pairs which are not available with GSI enhances tissue characterization through its ability to derive images that separateconventional contrast-enhanced CT materials such as calcium, iodine, and water.imaging. The make-up or composition “What really impresses me is the rich tissue characterization capability of spectral CT,” saysof the MD pairs can be selected based Dr. Tanenbaum. “To look at a dense brain lesion and know whether it is hemorrhagic,on the clinical question being investigated enhancing or calcified is very helpful, particularly in difficult case scenarios.”and materials of interest, such as iodine-water, iodine-calcium, or water-calcium. The 101 selectable energies and monochromatic images of GSI, explains Prof. zhang,GSI also produces a monochromatic enable easier and clearer detection of extremely tiny structures—for example, theimage, which is synthesized from the pancreatic duct and membranous structures such as the greater omentum. “ThisMD images and depicts how the object is rarely achieved using conventional CT,” he adds.would look if the X-ray source producedonly X-ray photons at a single energy.Specific tools have been created in the GSIViewer to support the data analysis of thisrich information. Tissue characterization “With the GSI-generated iodinecan be aided with the help of Hounsfield maps, I can clearly see theunit (Hu) spectral curves; metal artifactreduction is enabled by interactively severity of perfusion deficit.”switching to the optimal monochromaticenergy level. Additionally, material – Prof. Valentin Sinitsynidentification is made possible bydisplaying the effective atomic numberhistograms of objects, particularlykidney stones.12 A GE Healthcare CT publication • June 2011
  13. 13. GEMSToNE SPECTRAL IMAGING CLINICAL VALuE Pulmonary embolism Prof. Valentin Sinitsyn GSI represents what is lacking in a typical CT study, says Prof. Sinitsyn. After the Discovery CT750 HD scanner with GSI was installed at the Federal Center in November 2009, he immediately began investigations on pulmonary emboli. “Traditionally, CT provided an excellent depiction of the pulmonary vessels, thrombi and emboli,” he explains. “However, it could not give us full information on the Valentin Sinitsyn, MD, PhD, is Chief of the Radiology severity of pulmonary embolism obstruction or perfusion deficit defects. With the Department at the Federal Center of Medicine GSI-generated iodine maps, I can clearly see the severity of perfusion deficit.” and Rehabilitation (Moscow, Russia) and Professor and Chair of Radiology, School upon closer review, Prof. Sinitsyn discovered he could also detect tiny thrombus of Fundamental Medicine at Moscow State or embolus inside the pulmonary artery, which often causes the perfusion defect. university. Prof. Sinitsyn is also the elected President of the Russian National Congress “In patients with chronic embolism,” he adds, “it is clear that if we see multiple of Radiology 2011; Vice-President of the European perfusion defects there exists a strong indication to support surgical removal of the Society of Cardiac Radiology; and a member of the ECR Program Planning Committee. His thrombi.” He cites a recent study where the occurrence and severity of the perfusion interests include cardiovascular imaging, MR, defect as determined by spectral CT is a strong predictor of patient prognosis. contrast media, education, and internet and computer applications in radiology. Prof. Sinitsyn Prof. Dacher also uses GSI on a daily basis to generate iodine maps for lung perfusion has authored and co-authored more than studies (by centering the images on the iodine). Most exciting, he says, is the capability 110 articles and eight books on radiology and internet applications, edited Russian versions to view the pulmonary artery anatomy for helping to detect clots at the same time of two international textbooks on MRI and CT, he obtains a lung perfusion map. He can then use the anatomical and functional and serves on the editorial boards of the information—obtained during the same study—to assess the pulmonary emboli. “It International Journal of Cardiovascular Imaging, is very interesting to see there is no match between the extension of the pulmonary the Journal of Cardiovascular Magnetic Resonance, Diagnostic Imaging (Europe) and embolus and the pulmonary perfusion abnormality,” he explains. Imaging Decisions. In one particularly interesting case at the university Hospital of Rouen, pulmonary embolus was suspected in a patient presenting with chest pain. Prof. Dacher performed a GSI study and discovered the pulmonary artery was encased by a tumor. “The flow was limited and there was hypo perfusion that was completely obvious on the GSI study because we could see the anatomy and function,” he explains. “If we had performed only scintigraphy—historically the exam of choice for these cases— we would have only noted the reduced perfusion of the upper lobe.” This could have resulted in an incorrect diagnosis of pulmonary embolism and possibly led to the patient unnecessarily receiving an anticoagulant, he explains.Images courtesy of the Federal Center of Medicine and Rehabilitation (Moscow) About the facility The Federal Center of Medicine and Rehabilitation (Moscow) is well known as a modern surgical hospital specializing in high-tech neurosurgery, abdominal surgery, gynecology, orthopedics, and sports injury rehabilitation. The Department of Radiology performs all radiological examinations, including CT, MR, and nuclear scans, around-the-clock as needed. It is also focused on scientific research regarding new imaging technologies and contrast media agents. As an academic hospital, the Center offers residency and postgraduate programs as well as clinical faculty positions in the School of Fundamental Medicine at Moscow State university. The first-in-Russia Discovery CT750 HD scanner Figure 1A. A GSI iodine map depicts a wedge-shaped Figure 1B. A small embolus inside the corresponding was installed here in November 2009. perfusion defect in the 9th segment of the left lung. segmental branch of the left pulmonary artery can be seen with GSI. A GE Healthcare CT publication • June 2011 13
  14. 14. CLINICAL VALuE GEMSToNE SPECTRAL IMAGING Oncology For Prof. zhang, the most significant use of spectral CT is to quantitatively characterize lesions via the spectral Hu curve, which graphically displays the attenuation characteristic of a region across all 101 spectral energies. “using the monochromatic images, we can visualize anatomic and internal structures of lesions, which is important for early detection.” says Prof. zhang. He finds the “GSI is not simply material characterization and quantification very useful in helping him identify different types of lesions and diseases, and gaining information on cancer a new study area, at different stages. rather it is changing Additionally, GSI provides rich and reliable hemodynamic information of tissue with iodine quantification. “It helps us accurately identify infiltrated areas with the the way we think and iodine-based images,” adds Prof. zhang, “and with a reliable method to evaluate practice CT imaging.” hemodynamic status, we can evaluate therapy results more confidently.” – Prof. Xiao-Peng Zhang Lymphoma Images courtesy of Peking university Cancer Hospital and Institute Figure 2A. Affected lymph node of the neck. Figure 2B. Affected lymph node of the porta pulmonis. Figure 2C. Affected lymph node of the mediastina. Figure 2D. Affected node of the spleen.14 A GE Healthcare CT publication • June 2011
  15. 15. GEMSToNE SPECTRAL IMAGING CLINICAL VALuE one clinical question that a traditional CT exam cannot answer is whether or not a lesion enhances. This is often evaluated in terms of Hounsfield units, Prof. Xiao-Peng Zhang explains Prof. Sinitsyn. Yet the value assigned may not be precise, as the enhancement may be partially due to beam hardening artifact or artificially inflated via image processing. “When I see a small enhancement, I may not be able to determine if it is true or artificial,” he says. “By comparing water and iodine images, I get the information Xiao-Peng zhang, MD, is the Professor of Radiology, Peking university Health Science Center, and to quantify the area of interest based on the accumulation of iodine and objectively Chairman of Radiology Department, Peking determine if the lesion is a concern that requires follow-up.” university Cancer Hospital and Institute. Prof. zhang also holds the positions of Chairman of oncology Renal stones Imaging Committee, China Anti-Cancer Prof. Sinitsyn also uses GSI to assess renal stones. often, where there is one kidney Association; Managing Editor, Chinese Journal of Medical Imaging Technology; and Editor stone, there are more, so it is important to know the material composition. “GSI can of the Chinese Journal of Radiology, Chinese help quantify the renal stone, whether it is a calcified stone or predominantly a soft Journal of Clinical oncology, and Chinese Journal stone containing uric acid,” he says. The latter can be treated with techniques other of Practical Surgery. He authored three radiology textbooks and more than 80 research papers than surgery, Prof. Sinitsyn adds. globally. Prof. zhang’s research interests include abdominal and thoracic oncology imaging for the early detection, accurate staging, and therapy evaluation of cancer.Graph courtesy of Peking university Cancer Hospital and Institute In the Radiology Department of Peking university Cancer Hospital and Institute, a GSI team of 20 experienced radiologists and researchers, led by Professor Xiao-Peng zhang, has conducted more than 1,500 routine GSI scans and 20 pilot studies in the first three months of using GSI. They have achieved numerous promising results, submitted 30 research abstracts and 15 research papers to prominent journals of radiology. About the facility Peking university Cancer Hospital and Institute is one of China’s most-respected centers dedicated exclusively to cancer patient care, research, education, and prevention. Each year, more than 300,000 patients turn to the institute for cancer care in the form of surgery, chemotherapy, Figure 3. Spectral Hu curves show the same pattern of different affected lymph nodes in the same patient radiation therapy, immunotherapy, or combinations with lymphoma, which indicate these lymph nodes are of the same nature as lymphoma. of these and other treatments. A GE Healthcare CT publication • June 2011 15
  16. 16. CLINICAL VALuE GEMSToNE SPECTRAL IMAGING Reducing artifact With the continued increase in metal instrumentation—hip and knee prosthesis and spinal fusion, for example—the issue of artifact degrading image quality is becoming more pronounced, explains Dr. Tanenbaum. Reducing these artifacts is an important benefit that GSI provides in his daily practice. “Between 33% and 40% of our routine spine exams involve instrumentation,” he says. Images courtesy of Mt. Sinai Medical Center (New York) Figure 4. Note the lack of metal artifact in patient with spinal instrumentation in the 110 keV image on the right compared to the 70 keV image on the left.16 A GE Healthcare CT publication • June 2011
  17. 17. GEMSToNE SPECTRAL IMAGING CLINICAL VALuE Dr. Lawrence Tanenbaum name of authorTraditional techniques are challenged by implanted metal hardware, leading to imageswith beam hardening and streak artifacts.“Spectral CT generates virtually pristine images in these most challenging circumstances where traditional techniques often fail,” Dr. Tanenbaum adds. “We can restore the information in areas that were previously deteriorated by artifact and thus, substantially info about N. Tanenbaum, MD, FACR, Lawrence clinic, etc. improve the imaging results in these difficult cases.” is Director of MRI, CT, and outpatient/Advanced Development, Mount Sinai School of MedicineRecently at the European Congress of Radiology (ECR) 2011 annual meeting, (MSSM). The school opened its doors in the fallProf. Dacher presented a study demonstrating that he could more easily obtain high of 1968 and has since become one of the world’s foremost centers for medical andquality images of the femoral arteries in patients with metallic hip prosthesis by using scientific training. Located in Manhattan,GSI. “We cannot accept limitations in the investigation of the femoral artery, MSSM works in tandem with The Mount Sinaiso this may be a strong advantage of GSI.” Hospital to facilitate the rapid transfer of research developments to patient care and clinical insights back to the laboratory for further investigation.Enhancing contrast resolutionIodine-based contrast material used in CT imaging is very well suited to being About the facilitymanipulated—either enhanced or eliminated, explains Dr. Tanenbaum. “Not only Mount Sinai Medical Center, named to u.S. Newscan we make the iodine more useful, but it provides an opportunity to deal with & World Report’s 2009-2010 Best Hospitalssub-optimal contrast administration,” he adds. Honor Roll and ranked 19th nationally, treats nearly 47,000 inpatients and 427,000 outpatients Radiologists can either make the contrast more conspicuous in the image by adjusting each year. Renowned for its spinal cord and brain the energy or create a material-based image that eliminates visibility of the contrast. injury rehabilitation, Mount Sinai was the first medical school to establish a Department“With this capability, we have additional information in situations where, historically, of Geriatrics, as well as departments we’ve performed both a non-contrast and post-contrast CT study,” Dr. Tanenbaum adds. of environmental and occupational medicine. With more than 3,000 full-time and voluntaryProf. Dacher also sees an opportunity to use GSI in cases where optimal opacification physicians on staff, the hospital is a regional(contrast enhancement) is not ideal, particularly in older patients or those without leader in numerous specialties and the world’s only center for the diagnosis and care of Jewishgood venous access. “When we acquire images with GSI, it is possible to decrease genetic diseases.keV and enhance the small amount of contrast media in the patient vessel.”“Spectral CT generates virtually pristine images in these most challenging circumstances where traditional techniques often fail.” – Dr. Lawrence Tanenbaum A GE Healthcare CT publication • June 2011 17
  18. 18. CLINICAL VALuE GEMSToNE SPECTRAL IMAGING “We cannot accept limitations in the investigation of the femoral artery, so this may be a strong advantage of GSI.” – Prof. Jean-Nicolas Dacher Images courtesy of university Hospital of Rouen (France) Figure 5. 3D reconstructed image on left at 140 kVp demonstrates lack of imaging data due to artifact from metal instrumentation. Note the GSI image (right) at 70 keV plus MAR ( metal artifact reduction) clearly depicts the right femoral artery even in the presence of metal. Figure 6. GSI helps reduce artifact and provides a diagnostic-quality study even in the presence of metal instrumentation. The GSI image on the right at 70 keV plus MAR clearly demonstrates the reduction in artifact versus the 140 kVp image on the left.18 A GE Healthcare CT publication • June 2011