Advanced Imaging Technology. Chamaree Chuapetcharasopon, MD TIMAC-11, 13 March 2013
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1 Advanced Imaging Technology Chamaree Chuapetcharasopon, MD TIMAC-11, 13 March 2013
2 Advanced Imaging Technology Radiology Cardiology Gastroenterology OB
3 NEW 4D Ultrasound OB
4
5
6 Bronchoscopy Endoscopic imaging of the lung Flexible fiberoptic scope Patient is conscious and aware Exam tend to be repeated at follow up Multiple light source, fluorescence
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8 Otolaryngology Endoscopic imaging of the ear nose and throat Numerous types and styles of endoscopes Patient is conscious and aware Exams tend to be repeated at follow up Video frame rates can reach 200 fps Requires synchronized audio
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10
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13 Ophthalmology Many types of image devices Non dilated, Non touch examination 30
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15 Pathology Anatomical Pathology Require high definition details Better than 0.1 micron resolution Rapid (subminute) image gathering True color >20 GB images
16
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18 Dr Keith Foord East Sussex Hospitals, UK
19 Dr Keith Foord East Sussex Hospitals, UK
20 40 Dr Keith Foord East Sussex Hospitals, UK
21 Image users real time guided therapy and surgery Sinus surgery. The cross lines show The position of the probe on the corresponding CT in x,y and z axes midturbvirtendosc.jpg GE Medical Systems
22 Digital OR Images BrainLAB AG Smith and Nephew website :UPMC Southside Hospital
23 Advanced Imaging Technology Gastroenterology Orthopedics Otolaryngology Pathology Cardiology OB-Gyn Radiology
24 Advanced Imaging Technology Terminology General Radiology ร งส ว ทยาท วไป Diagnostic Radiology ร งส ว น จฉ ย Interventional Radiology ร งส ร วมร กษา Radiation Oncology (Therapy) ร งส ร กษา Nuclear Medicine เวชศาสตร น วเคล ยร
25 Advanced Imaging Technologies IT World ( Information Technology ) Digital Data Data Transfer
26 Advanced Imaging Technology Analog to Digital Analog: Camera + Film Post Processing Picture Digital: Digital Camera + Data storage Data Transfer Computer Display Display Monitor Printer Internets Save file CD ROM Hard Drive Picture Scanner Digital Data
27 Advanced Imaging Technology Analog: Plain film Mammogram Special Procedure Upper GI, Barium Enema, IVP, Angiogram Ultrasound ( US ) NM ( Nuclear Medicine ) PET Scan ( Positron Emission Tomography ) Digital CR, DR FFDM Full field digital mammogram CT Tomosynthesis MRI
28 Advanced Imaging Technology Digital Data: CT ( Computed Tomography ) MRI ( Magnetic resonance imaging ) NM ( Nuclear Medicine ) PET (Positron Emission Tomography) CR, DR (computed radiograph, digital radiograph) Mammogram Ultrasound DSI (digital subtraction imaging) DSA (digital subtraction angiogram)
29 Advanced Imaging Technology CR/DR CT scan MRI PET/CT PET/MRI HIFU
30 Old days
31 Introduction to CR
32 Introduction to CR
33 Introduction to CR and display monitors
34 DR Wired Wireless
35
36 Advanced Imaging Technology CT scan (Computerized tomography) Conventional CT Spiral, helical CT 64 slices 256 slices 640 slices Dual sources
37 CT Scan Third generation Conventional Spiral
38 MSCT New Concepts to Understand
39
40 Many vendors
41 Example of CT work place
42 CAC Scoring
43 CT Contrast study
44 LAD disease
45 Volume Rendering Whole heart images
46 CT Chest Whole chest images
47
48 Other clinical applications
49 Advanced Imaging Technology MRI Low field, mid filed, high field 1.5 Tesla 3 Tesla Open MRI Standing MRI
50 MRI High field MR machine
51 Phase array body coil
52 Different images of the same territory T1 T2 Proton density
53 MRI CT MR and CT of HCC cirrhotic liver
54 Hemangioma
55 MRCP
56 MRCP
57 Neurovascular application
58 Nerve fiber tracking
59 Peripheral vascular coil
60 Peripheral vascular images
61 Contrast Enhanced MRA
62 Advanced Imaging Technology PET/CT PET/MRI
63 PET/CT (Positron Emission Tomography/ Computerized Tomography)
64 Anatomy vs Function Anatomical (CT) Functional (PET) Anato-metabolic Information Anatomy, morphology Function, metabolism Anatomy+Function Detection Size, morphology Altered metabolism Size, Location, Metabolism Image details No or indirect Little, or no anatomy Function+Anatomy function
65 Principle of PET e + Neutron deficient isotope: unstable Positron emission Positron meets electron:annihilation 511 kev -ray e kev -ray Emission is on straight line!
66
67 Uptake of FDG Kapoor, V. et al. Radiographics 2004;24:
68 PET/CT Fused PET/CT FORE AWOSEM CT PET Upper limit Topogram Lower limit CT acquisition attenuation correction scatter correction
69
70 Why PET/CT? - Difference from other Modality Anatomy vs Function X-ray CT MR PET
71 BI PET CT SIEMENS PET-CT (64 SLICES)
72 Evaluation Radionuclides given Having PET/CT Scan
73 Indications for PET imaging with FDG Breast cancer Cervical cancer Colorectal cancer Esophageal cancer Head and neck cancer (non-thyroid, non-cns) Lymphoma Melanoma Non small cell lung cancer Solitary pulmonary nodules Follicular cell thyroid cancer
74 Radionuclides Radionuclides used in PET scanning are typically isotopes with short half-lives carbon-11 (~20 min), nitrogen-13 (~10 min), oxygen-15 (~2 min), fluorine-18 (~110 min) rubidum-82(~1.27 min).
75 PET/MRI
76 Advanced Imaging Technology CR/DR CT scan MRI PET/CT PET/MRI HIFU
77 What is HIFU? (High Intensity Focused Ultrasound) High energy focused ultrasound beam. Brought to a tight focus in tissue at a distance from the source. Absorption of the energy leads to tissue heating. Causes localized temperature rise at the focal point. Sharply demarcated area of coagulative necrosis. No damage to overlying and surrounding tissue.
78 Lesion of coagulation necrosis at focus (12x3mm) Skin Tumour Target organ (e.g. liver) Transducer Undamaged tissue in front of focus
79 HIFU 3-Dimensional Therapy Plan One pulse of HIFU exposure Multiple-pulse Scanning beam Line Volume Slice
80 Mechanisms of HIFU Ablation Thermal Effect --Heat (56-100⁰ C)
81
82 Clinical Advantages of HIFU HIFU does not suffer from the following problems associated with Radiotherapy & Chemotherapy: Lethargy Sickness Lowered immunity to infection Hair loss Haematological disorders Multiple hospital visits
83 Clinical Advantages of HIFU One time Treatment Real-time US-guided Procedure Low cost Non Toxic Not limited by tumour size Short hospital stay (one day) Minor complications
84 Operator Console 2. γ-motion Device (rotates transducer about x-axis [long axis of bed]) 3. Frequency Generator and amplifier 4. ψ-motion Device (rotates transducer about y-axis [transverse]) 5. Integrated Treatment Transducer (diagnostic US probe and HIFU transducer) in degassed water reservoir 6. 4-dimension Motion Device (translates transducer in x, y and z, rotates plane of diagnostic image) 7. Treatment Bed
85 Model-JC Focused Ultrasound Tumour Therapy System Regulatory Approvals: Europe: CE, MHRA China: SFDA Korea: KFDA
86
87 New Haifu Products for Clinical Trial An MRI-guided Extracorporeal HIFU Device (Haifu-Siemens)
88 Minimal invasive treatment of malignant hepatic tumors 1. Radio-frequency ablation 2. Microwave ablation 3. Laser ablation 4. Cryoablation 5. Ethanol ablation 6. Chemoembolization
89 Minimal invasive treatment of malignant hepatic tumors Rita 15 G, 4-8 Prong, Radiotherapeutics 14 G10 Prong Radionics17 G/3- needle
90 Minimal invasive treatment of malignant hepatic tumors CC/03
91 Minimal invasive treatment of malignant hepatic tumors
92 Minimal invasive treatment of malignant hepatic tumors
93 Minimal invasive treatment of malignant hepatic tumors
94 Minimal invasive treatment of malignant hepatic tumors
95 Minimal invasive treatment of malignant hepatic tumors TACE
96 Minimal invasive treatment of malignant hepatic tumors CC/03
97 Minimal invasive treatment of malignant hepatic tumors CC/03
98
99 Advanced Imaging Technology Take home messages New technologies occur every day. How to use them appropriately? We (who?) need to consider Appropriateness criteria Cost effectiveness Patient benefit
100 Thank you for your attention
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