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www.healthcare-in-europe.com 25ULTRASOUND Assessing chemotherapy Easing ultrasound operation Ultrasound presents an alternative to radiation Touch system customises to user needs Injecting toxic chemicals into the body to kill cancer cells is a physically and mentally brutal experience for patients. The treatment cost is equal- ly brutal for healthcare systems. Yet, often after six months of dif- ficult treatment, patients may hear that the chemotherapy did not stop or kill the cancer. There is now a way to find out, in just 30 days and at a cost of just €183, whether the treatment is doing any good. A further plus: the exam does not expose a patient to radiation. This three-minute exam, with an injection of a contrast agent, micro- scopic air bubbles illuminate blood circulation for ultrasound probes and can expose tumours. Proven effective through clini- cal studies and recommended by WFUMB and EFSUMB – the World and European and federations for ultrasound in medicine and biology – the dynamic contrast-enhanced ultrasound exam (DCE-US) can determine whether chemotherapy is working and help the oncolo- gist to decide whether treatment should be stopped, continued or even increased. Nathalie Lassau MD, from the Gustave Roussy Institute for cancer research in Paris, has been work- ing with clinicians and ultrasound Carestream Health, the medical imaging and healthcare IT spe- cialist, presented its latest innova- tion, the Touch Ultrasound System at this year’s ECR. This system offers a configurable all-touch control panel, a powerful proces- sor, plus other innovative tools. Daniela Zimmerman and Mélisande Rouger, from European Hospital, interviewed Andrew J Hartmann, the firm’s General Manager of the Global X-ray & Ultrasound Solutions division, to explain how the new platform promises to improve user experience EH: Carestream’s long love affair with film is part of its Kodak leg- acy. What drove the firm towards creating innovations in ultra- sound? Andrew Hartmann: ‘Film is a big part of our legacy and an important component of our business. We sell in over 180 countries and our business is expanding; but, beyond film, we are also a leader in digital X-ray, both CR and DR, as well as healthcare IT, printers, and dental solutions. We are a growing com- pany and our customers are looking to us to expand into other modali- ties. Ultrasound is one of the fastest growing healthcare modalities and is a six billion dollar market today. It’s certainly an area where we felt we could innovate and answer our customers unmet needs, while lever- aging our existing sales and service infrastructure. Ultrasound is a logi- cal step forward.’ What do you think makes Touch so special? ‘One of the key differentiating fea- tures is the sleek, modern, all-touch control panel. The only button on the system is the Power button. The primary controls have the tactile feedback of traditional keys, via distinct etched patterns, while the unique design has the additional flexibility of configurable soft con- trols. ‘We like to think of ultrasound as a modality in which the user and the procedure define how the sys- tem should be set up – a little like adjusting the driver’s seat in a car. When I log into Touch’s system, it knows the way I like to drive it. This customisation will really simplify workflow. ‘We also tackled the issue of sterili- sation. The Touch’s smooth, sealed surface makes it effortless to clean. ‘The Touch cart has been designed with ergonomics in mind. There are multiple user adjustments to help minimise injury risk factors and also increase the user’s efficiency and convenience. Of course, image quality is of pri- mary importance and the Touch sys- tem will have extremely high image quality driven by graphic processing units (GPU’s) for fast response and low noise. ‘Voice of the customer played a key role in our system design. We developed the system based on their daily challenges. We saw an oppor- tunity to innovate.’ Do you listen to customers differ- ently from your competitors, with their longer history in this field? ‘Not having legacy products allowed us to start with a clean slate and look at what’s challenging in depart- ments from a use-of-ultrasound per- spective. What are the features and functionalities people are looking for, but cannot be found in today’s solutions. ‘If we introduced a product that was the same as everybody else’s and wanted to become an ultrasound supplier, we could have just bought any of the small companies that have products. ‘When we step into a modality our intention is to become a major play- er. When we presented our mobile X-ray system, the market was satu- rated and dominated by two or three vendors. We now own 25-30% of the market share – because we innovate and do things differently.’ Along with radiology, ultrasound is used in internal medicine, car- diology and other medical disci- plines. Does Carestream have a position in those? ‘Our first entry will be for a premi- um product for general imaging in radiology. We have plans to expand the portfolio using the same archi- tecture and same user interface for more value tier systems as well as other disciplines.’ When purchasing for a hospi- tal, economic constraints often have the last word. How do you address this issue? ‘The economic component is cer- tainly a big part of the conversa- tion. Carestream intends to design a family of systems from premium high-end to point of care, covering a variety of disciplines. ‘All will use the same transducers and have the same user interface and the same architecture. This will allow facilities to maximise their return on investment by lowering training costs, as well as being able to share transducers across equip- ment and across departments. ‘We are also develop- ing a service strategy that will reduce over- all cost of ownership and will make it easy for the facility to have high uptime and low maintenance costs.’ companies for 10 years to carefully advance this disruptive procedure through demanding requirements for clinical validation. Having won approval and recom- mendations for the technique in Europe, she says her goal is now to win approval in the USA, where the contrast agent has recently been approved. ‘We can provide the oncologist with the results of the assessment in real-time – no one is able to do this with either a CT or an MRI Scanner.’ Key to her work has been a col- laboration with Toshiba Medical sys- tems that was the only ultrasound system manufacturer to provide the raw linear data essential to cre- ate the calculations and analysis of tumour response to chemotherapy. Today, all major ultrasound manu- facturers have opened their systems to enable this breakthrough tech- nique. It has also attracted the interest of pharmaceutical companies, as keen as patients to know if their therapies are effective. ‘Cancer has become a chronic dis- ease,’ said Lassau. ‘And today there are many drugs to treat carcinoma. It’s possible that a patient will start with one drug, then be switched to another drug, and so on. In my institution, a single patient may be tested across six different drugs. ‘If a patient’s doctor is follow- ing the current international stand- ards, then the doctor will perform a Response Evaluation Criteria In Solid Tumours (RECIST) evaluation, which uses CT. This means the patient is being exposed to radia- tion to evaluate the effectiveness of the chemotherapy,’ she pointed out. ‘There is a strong association, sup- ported by articles in leading medical journals, where they show there is a risk for inducing a secondary cancer through the radiation of patients with CT.’ Performing a CT perfusion exam to see whether chemotherapy is working means exposing the patient to 20 millsieverts (mSv) of radiation for each exam. ‘I don’t know about other countries, but I know that, in France, 20 mSv is the maximum dose allowable for one patient dur- ing a full year. With cancer patients there is a risk of scanning them every two or three months,’ Lassau explains. Some people might say that if a patient is dying from cancer, then the risk of creating a second cancer with radiation is not as important. ‘This is a cynical view,’ according to Lassau. ‘There has been significant progress made in chemotherapy for many types of cancer and the life expectancy of patients is greatly increased.’ Patients are especially concerned about the risks of radiation expo- sure, and she said patient advocacy groups are helping to increase the awareness that there is now an alternative way of learning if chemo- therapy is working. Lassau continues to advance the DCE-US, currently leading a new multi-centre clinical trial to demon- strate the technique’s effectiveness and reproducibility of results. The next step, she says, is to develop the system using ultrasound imaging in 3-D. ‘All ultrasound companies now offer 3-D probes and we want to show a full acquisition to be sure we are studying the total tumour.’ Nathalie Lassau, from the Ultrasound Unit, at the Institut Gustave Roussy, University Paris-Sud, France Andrew J. Hartmann, General Manager, Global X-Ray & Ultrasound Solutions, Caretream Health, Inc, Rochester USA Hepatic metastasis before (upper images) and after 42 days of anti-angiogenic treatment (lower images). B-mode and contrast-enhanced ultrasound image with time- intensity-curve analysis

EH 2_2015

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