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    Default Cellphone Technology Speeding Up CT Scans, Ultrasound Warning Signal For Breast Cancer

    The 49th Annual Meeting of the American Association of Physicists in Medicine (AAPM) will take place July 22-26, 2007 in Minneapolis, MN, at the Minneapolis Convention Center. Expected to be one of the most highly attended AAPM meetings to date, the conference will feature over 1,100 scientific papers on subjects at the intersection of medicine and physics. Many of these topics deal with the development of state-of-the-art imaging and therapeutic devices for cancer, and the new techniques that go along with them.

    The scientific program will begin on Sunday, July 22 at 9:30 AM and conclude on Thursday, July 26 at 5:30 PM. Scientific abstracts that scored high during the review process were identified as "Reviewer's Choice" selections. More details on these noteworthy presentations can be found on a special meeting webpage (http://www.aapm.org/meetings/07AM/SpecialRecognition.asp).

    MEETING HIGHLIGHTS

    Meeting highlights include: a new discovery that ultrasound might provide a warning signal for breast cancer; a multiplexing technique, similar to ones used in communications technology, to produce faster computed tomography (CT) images; a new device that may make proton cancer therapy a much more widespread treatment option; and a hybrid magnetic resonance imaging /x-ray machine that may lead to improved cancer treatments.

    ABOUT MEDICAL PHYSICISTS

    If you have ever had a mammogram, an ultrasound, an x-ray, a CT or a PET scan, chances are reasonable that a medical physicist was working behind the scenes to make sure the imaging procedure was as effective as possible. Medical physicists help to develop new imaging techniques, improve existing ones, and assure the safety of radiation used in medical procedures. They contribute to the development of therapeutic techniques, such as the radiation treatment and prostate implants for cancer. They collaborate with radiation oncologists to design cancer treatment plans. They monitor equipment and procedures to insure that cancer patients receive the prescribed dose of radiation to the correct location. AAPM's annual meeting provides some of medical physicists' latest innovations, which may be coming soon to a hospital near you.

    HIGHLIGHTS OF THE SCIENTIFIC PROGRAM

    The following highlights represent some of the many noteworthy talks that medical physicists will present at the meeting.

    I. MEASURING BREAST DENSITY WITH ULTRASOUND

    II. BORROWING "MULTIPLEXING" TECHNIQUES FROM TELECOMMUNICATIONS MAY SIGNIFICANTLY SPEED UP MEDICAL SCANS

    III. INNOVATIVE PHYSICS DEVICE MAY REVOLUTIONIZE PROTON THERAPY

    IV. HYBRID MRI-RADIATION THERAPY MACHINE MAY IMPROVE TREATMENT FOR MANY CANCERS

    V. A SOLID STATE X-RAY IMAGE INTENSIFIER

    VI. NEW 3-D IMAGING SYSTEM FOR IMAGE-GUIDED INTERVENTIONS

    VII. 3D BREAST IMAGING USING GAMMAS AND X RAYS

    VIII. SMALLER IS BETTER FOR HEAD AND NECK IMAGING

    I. MEASURING BREAST DENSITY WITH ULTRASOUND

    Studies by scientists at the Karmanos Cancer Institute and Wayne State University in Michigan have discovered a correlation between the speed of ultrasound transmitted through breast tissue and the density of that tissue. This is potentially important because high amounts of dense breast tissue are associated with increased breast cancer risk. Using ultrasound avoids the use of ionizing x-rays used in typical mammography.

    The researchers are part of a team that has been developing a new form of ultrasound tomography, one in which the patient is in the prone position, with a breast projecting down into a bath of water. The breast is surrounded by a ring-shaped transducer for sending sound waves into the breast from all sides. The resulting ultrasound detection captures both reflected and transmitted sound waves. From this, an ultrasound percent density (USPD)--thought to be a good proxy for mammographic density--can be determined.

    The method has been tried out in a clinical trial with a cohort of 100 patients and shows that USPD corresponds well with both qualitative and quantitative mammographic breast density measures. One of the scientists, Carri Glide, says that they hope to gain FDA approval and introduce the device into general use. Further information about the device can be found at http://www.aapm.org/meetings/07AM/SpecialRecognition.asp. [Thursday, July 26, 2007, Papers at 2:30 PM (TH-D-M100J-6), 5 PM (TH-E-L100J-6), and 5:12 PM (TH-E-L100J-7).]

    II. BORROWING "MULTIPLEXING" TECHNIQUES FROM TELECOMMUNICATIONS MAY SIGNIFICANTLY SPEED UP MEDICAL SCANS

    By borrowing techniques used in telecommunications technology, computed tomography (CT) scanners may eventually see data collection speeds increase by hundreds of times, leading to better images, faster imaging procedures, and potentially lower x-ray exposures. A University of North Carolina team has pioneered a method that collects images from many sources at once, instead of the current serial method of data collection.

    Modern CT scanners, widely used for diagnostic medical imaging and security screening, collect over 1,000 images in less than one second by high-speed rotation of an x-ray tube around the object. However, the data is collected in a serial fashion, essentially one piece of data at a time.

    Multiplexing represents an innovative solution for potentially speeding up CT scans. A widely used concept in many communications-related fields, multiplexing is a process of combining multiple signals to form one composite signal for transmission. For the multiplexing CT scanner, multiple x-ray sources fire simultaneously to capture images from multiple views at the same time. In general, a factor of N/2 (N=total number of images) increase in the speed can be achieved using the multiplexing technique. For example, the speed of clinical CT scanners that acquire around 1,000 views per gantry rotation would increase by a factor of 500.

    A team from the University of North Carolina, Chapel Hill, has been developing multiplexing CT scanners for several years. The team very recently created a 25-pixel multiplexing CT scanner, but engineering difficulties lie in front of the ultimate goal, a scanner with approximately 1,000 x-ray pixels. According to team leader Jian Zhang, the cost of these machines would not rise significantly, as new technology enables hundreds of x-ray cathodes to be fabricated on a single silicon wafer. (Monday, July 26, 2007, 5:12 PM, Paper MO-E-L100J-7)

    III. INNOVATIVE PHYSICS DEVICE MAY REVOLUTIONIZE PROTON THERAPY

    Using innovative physics, researchers have proposed a system that may one day bring proton therapy, a state-of-the-art cancer treatment method currently available only at a handful of centers, to radiation treatment centers and cancer patients everywhere. Compared to the x rays conventionally used in radiation therapy, protons are potentially more effective, as they can deposit more cell-killing energy in their tumor targets and less in surrounding healthy tissue. However, to kill tumors, the protons must be accelerated to sufficiently high energies, which currently must be achieved in large, expensive devices called cyclotrons or synchrocyclotrons that cost hundreds of millions of dollars and occupy a room the size of basketball courts.

    Thomas Mackie, a professor at the University of Wisconsin and co-founder of the radiation therapy company TomoTherapy, will present a proton-therapy design based on a much smaller device known as a "dielectric wall accelerator" (DWA). Currently being built as a prototype at Lawrence Livermore National Laboratory, the DWA can accelerate protons to up to 100 million electron volts in just a meter. A two-meter DWA could potentially supply protons of sufficiently high energy to treat all tumors, including those buried deep in the body, while fitting in a conventional radiation treatment room.

    The DWA is a hollow tube whose walls consist of a very good insulator (a dielectric). When most of the air is removed from the tube to create a vacuum, the tube can structurally withstand the very high electric-field gradations necessary for accelerating protons to high energies in a short distance.

    In addition to its smaller size, a DWA-based proton therapy system would have another benefit-it could vary both proton energy and proton-beam intensity, two variables that cannot both be adjusted at the same time in existing proton-treatment facilities. This capability could lead to "intensity-modulated proton therapy" (IMPT), the proton version of the x-ray-based intensity modulated radiation therapy (IMRT) technique which has become a popular method for delivering precise radiation doses to the parts of a tumor. Mackie cautions that clinical trials of the system are at least five years away. But if the DWA approach proves feasible, protons may eventually represent a widespread, rather than limited, option for treating cancer. (Thursday, July 26, 2007, 11:36 AM, Paper TH-C-AUD-9.)

    IV. HYBRID MRI-RADIATION THERAPY MACHINE MAY IMPROVE TREATMENT FOR MANY CANCERS

    Bringing together the high-quality 3D images of MRI with the intense tumor-killing x-rays of a linear accelerator, scientists at the Alberta Cancer Board are building a prototype that could for the first time enable powerful x-ray beams to become a viable treatment option for liver, stomach and pancreatic cancers, which currently must be treated with surgery, drugs, or internal radioactive seeds in most cases. The hybrid device could also improve results for all cancer patients receiving radiation therapy.

    Using a process called Advanced Real-Time Adaptive RadioTherapy (ART), the prototype system will allow for near-real-time 3D magnetic resonance imaging (MRI) at the same time radiation is being administered. MRI can provide higher-quality images of tumors and organs than x-rays or computed tomography (CT) machines. In addition, it is the only imaging method that can truly provide high-quality, near-real-time 3D images inside the body.

    Combining a linear accelerator used for radiation treatments and an MRI is difficult because they function on incompatible scientific and engineering principles. ART overcomes the issue by rotating an MRI machine and a linear accelerator together. The two machines are fixed with respect to each other and rotate in unison around the patient, obtaining images and delivering radiation treatment from all angles. This fixed-system concept reduces electromagnetic interference between the linear accelerator and MRI.

    A finished prototype is expected by December 2007. According to the researchers, the machine will improve the accuracy of radiation treatments for solid tumors, thereby reducing side effects. In addition, it could improve treatment for lung and prostate cancers where it is still difficult to administer sufficient radiation doses to obtain a better chance of a cure. (Tuesday, July 24, 10 AM, Paper TU-C-M100F-1)

    V. A SOLID STATE X-RAY IMAGE INTENSIFIER

    A solid-state x-ray image intensifier (SSXII), now in development, should greatly improve the spatial resolution of medical x-ray imaging. In angiography (imaging blood vessels using higher x-ray exposures to provide a very high-quality, low-noise diagnostic image) and fluoroscopy (real-time imaging at lower x-ray exposures for image guidance) it is important to minimize the x-ray dose to the patient and to maximize the sensitivity of the detectors recording the image. Usually an x-ray image intensifier (XII) or a flat-panel detector (FPD) is employed. These are devices used for converting the x-ray image into a digital image. The XII suffers from inherent image distortions due to the method of image intensification including susceptibility to the earth's magnetic field. As a result, the XII is currently being replaced by the newer FPDs which overcome these distortion problems. Unfortunately the flat-panel detectors themselves suffer from excessive instrumentation noise, resulting in poor image quality at the lower x-ray exposures required for fluoroscopy. Both detectors have limited spatial resolution.

    Now, scientists at the University at Buffalo are developing a solid state version of the traditional x-ray image intensifier, one which relies upon electron-multiplying charge-coupled devices (CCDs) to provide variable signal amplification in solid-state. The result should be a device which incorporates all the positive features of current state-of-the-art fluoroscopic imagers, but with minimal image distortions unaffected by magnetic fields, extremely low instrumentation noise, variable sensitivity down to very low x-ray exposures, and more than double the spatial resolution. Andrew Kuhls, working in Professor Stephen Rudin's medical imaging physics group, says that in-vivo testing of the new device is planned, with clinical trials to follow. [Wednesday, July 25, three talks: WE-C-L 100J-3 (10:24 AM), WE-C-L 100J-4 (10:36 AM), WE-C-L 100J-6 (11 AM).]

    VI. NEW 3-D IMAGING SYSTEM FOR IMAGE-GUIDED INTERVENTIONS

    A new type of cone-beam computed tomography (CBCT) imaging system could enable surgeons and interventional radiologists to perform minimally invasive procedures under the guidance of 3-D images acquired during surgery with sub-millimeter spatial resolution. Medical physicists and engineers from the University Health Network in Toronto and Siemens Medical Solutions will present this technology.

    Image-guided interventions have conventionally relied on image data acquired before the procedure on a diagnostic CT or magnetic resonance (MR) scanner. However, reliance on preoperative images does not allow visualization of changes imparted during a surgical procedure, such as seeing what remains of a tumor after it is removed.

    This imaging promises to overcome these conventional limitations by providing image updates during the procedure. One new technology showing particular promise is CBCT implemented on a surgical C-shaped arm.

    Research at the University of Toronto, headed by Jeffrey Siewerdsen, in collaboration with clinical researchers at the University Health Network and at Siemens Medical Solutions (SMS), has yielded a 3-D imaging technology that could provide physicians with sub-millimeter spatial resolution and soft tissue visibility during surgery in near real-time. The technology involves the development of CBCT on a mobile C-arm to acquire a full-volume image in a single rotation around the patient.

    While the image quality achieved with early cone-beam CT prototypes is not quite equivalent to that of a high-performance diagnostic CT scanner, image quality has been shown to be sufficient to guide surgeons and radiologists with respect to soft-tissue targets and critical structures.

    Patients have been successfully treated with the prototype in a research setting, with trials underway in a broad spectrum of surgical and interventional procedures ranging from tumor ablation to orthopedic surgery and brachytherapy. High-quality intraoperative imaging provided by C-arm CBCT is expected to dramatically improve surgical performance and expand the application of minimally invasive interventions to cases that would be otherwise untreatable. [Wednesday, July 25, 8:55 AM (WE-B-L100F-2), Thursday, July 26, 11 AM (TH-C-M100J-6 ), and 2:54 PM (TH-D-L100J-8)]

    VII. 3D BREAST IMAGING USING GAMMAS AND X RAYS

    Scientists at Duke University combine the best aspects of x-ray computed tomography (CT) scanning with single photon emission computed tomography (SPECT), which is the single-gamma-ray counterpart of positron emission tomography (PET) scans, to obtain both anatomical and functional information using a single comfortable gantry. The computer reconstruction of the continuously acquired data employs an iterative algorithm that handles both CT and SPECT data in turn. The new features of this hybrid system include, first on the SPECT side, a spatial resolution of 2.5 mm and an energy resolution of 6%. On the computed tomography (CT) side, with a dose as low as one-tenth that used in normal x-ray screening mammography, the imaging can reveal normally hard-to-see lesions near the chest wall, and the spatial resolution is 0.5 mm. The SPECT imaging detects biochemical changes long before structural changes are observable, a valuable feature for early screening or for following therapy. Martin Tornai says that early clinical trials of the new device are going well. (Wednesday, July 25, 2:42 PM, Paper WE-D-L100J-8.)

    VIII. SMALLER IS BETTER FOR HEAD AND NECK IMAGING

    MiniCAT, a flat-panel-display-based (FPD) imaging system, yields head and neck images that are superior to those from much larger and bulkier computed tomography (CT) scanners. This is the conclusion of a scientific study that includes Web Stayman of Xoran Technologies, Inc., the Ann Arbor, MI-based company that makes the MiniCAT scanner. Using MiniCAT may provide additional advantages to the patient and physician, as it's designed specifically to deliver low radiation doses to the head and neck. Whereas CT scans usually require a trip to a different facility or department, MiniCAT's one-square-meter footprint enables it to be installed at the point-of-care, which includes installation within a specific department at a hospital, a surgical or imaging center, or a doctor's office.

    Central to the MiniCAT design is a flat-panel x-ray detector, based on the same kind of technology as flat-panel monitors for computers except they detect (x-ray) photons rather than give off visible light. Because of the small size of their detection elements, these panels have the capacity for extraordinarily high resolution in all directions.

    The researchers compare images from a traditional CT and the MiniCAT for imaging of the temporal bone, the portion of the skull that contains the inner ear and its components. This portion of the human anatomy is notoriously difficult to image due to the very fine details and the alignment of some features on non-standard imaging planes. The width of one of the inner ear bones, the stapes, is about the length of the date on a U.S. dime. In the comparison, the researchers find details (a facial nerve canal) that are clear in the MiniCAT scan and obscured in the traditional CT. To be able to resolve such important structures may have an important impact on clinical diagnosis and treatment of temporal bone diseases. (Thursday, July 26, 2007, 11:36 AM, Paper TH-C-AUD-9.)

    ADDITIONAL SESSIONS OF INTEREST

    This year's President's Symposium, chaired by AAPM President Mary Martel (UT MD Anderson Cancer Center), explores the concept of using medical images as biomarkers for monitoring patient response to drug and radiation therapy (http://www.aapm.org/meetings/07AM/PRAbs.asp?mid=29&aid=8005). At the meeting's professional symposia, speakers will tackle topics such as developing medical physics technical standards, the challenges of introducing new technology into the clinic, and special issues for scientists in signing legal statements related to medical treatment. The educational symposium contains sessions on interacting with the news media, using PET and SPECT imaging in optimizing treatment plans, and efforts to increase the medical physics education of diagnostic radiology residents.

    ----------------------------

    ABOUT AAPM

    AAPM (http://www.aapm.org/) is a scientific, educational, and professional organization of more than 6,000 medical physicists. Headquarters are located at the American Center for Physics in College Park, MD. Publications include a scientific journal ("Medical Physics"), technical reports, and symposium proceedings.

    Source: Ben Stein
    American Institute of Physics












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    Default Cellphone Technology Speeding Up CT Scans Ultrasound Warning Signal For Breast Cancer

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    Default Cellphone Technology Speeding Up CT Scans Ultrasound Warning Signal For Breast Cancer

    Is it possible to charge for contrast injection under ultrasound guidance for a diagnostic mammogram?

    Our radiologists want to inject some contrast into a breast with US guidance, prior to a dx mammo in order to correlate what is seen on US as a followup to a prior mammo.

    Here’s what the Breast Cooridinator told me.
    “When there is an abnormality on mammogram and they aren’t sure if the area they see on US is the same they inject the optiray under US and then take a mammogram to see if they correlate”

    Based on that, I am thinking that she’s already had a mammo; US was recommended and performed but now they are trying to see if the area in the US matches the mammo, so we inject contrast under US guidance and then they repeat a mammo.

    Any thoughts or suggestions?

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