EH 3_2015

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Quick & easy to disinfect, sealed front panel Built-in rear cable cover reduces clutter Corning® Gorilla® Glass for excellent scratch resistance Sleek, intelligent & ergonomic design www.healthcare-in-europe.com 21RADIOLOGY more essential details Big data in breast diagnostics ight s monitors Multiparametric imaging Report: Karoline Laarmann The vast amounts of data accumulat- ing in breast diagnostics require new methods to extract clinical infor- mation in a practical way. When dealing with large amounts of data that is too big or too complex to be analysed with traditional data pro- cessing applications, the talk today is of ‘Big Data’. The data volume accumulating in breast diagnostics has become increasingly complex over recent years: multiparametric MRI including diffusion imaging and MRI spectography, positron emission tomography (PET) and tomosynthe- sis (3-D mammography) along with the various ultrasound procedures, generate such vast amounts of data that its evaluation is turning into a Herculean task. ‘It’s becoming ever more difficult to view and sort all the data and finally to make a diagnosis for the individual radiologist,’ accord- ing to Associate Professor Dr Pascal Baltzer, at the Clinic for Radiology and Nuclear Medicine, Medical University of Vienna, who lectured on Big Data in Breast Diagnostics at the 96th German Radiology Congress. Multiparametric MRI for instance – Baltzer’s specialist area of research – delivers a multitude of results. Based on blood pressure measurements alone, through signal changes caused by contrast media injected, different distribution volumes and perfusion parameters can be calculated with pharmacokinetic models (such as perfusion rate of tissue, extracellular distribution volume). ‘If you then add the other technologies, all of which show different functional aspects of a tumour – be it biochemistry, microanatomy or perfusion – you obtain a very comprehensive but also very complex image of the tumour,’ Baltzer explains. However, this also raises a number of questions: What does the parameter measured mean in an individual case? How should individual parameters be combined? Could a parameter that proved mean- ingful in a study also extract usable information under clinical conditions and with other devices? ‘There is significant demand for empirical data acquisition that not only validates the above mentioned technologies multicentrically, but also examines them as to which data is required and which isn’t,’ he points out, turning to a dilemma that arises. On the one hand we’d like to visual- ise the tumour in any possible bio- chemical and molecular way but, on the other, the images obtained also need to be converted into a practi- cal concept. Radiologists in practices outside academic settings obviously need to be able to use the data,’ he emphasises. Therefore he believes that the order of the day is data min- ing. ‘This means disposing of the data ‘waste’ within the ‘mine’ of data whilst extracting the diamonds.’ By using methods of machine learning and multivariate statistical models, the flood of data is reduced and pat- terns are recognised. This obviously requires a correspondingly large database – containing many hundred or even thousands of multiparamet- ric sets of data. ‘This is only available in very few facilities,’ Baltzer regrets. The Medical University of Vienna, where she carries out her research, is one of those facilities. The point of this undertaking is solid: Whilst the approach with other organs, such as the prostate, can be described as ‘active surveillance’ in breast cancer diagnostics there is a heated debate involving the terms ‘over diagnosis’ followed by ‘over therapy’. Baltzer emphasises: ‘We know from studies that a not insignificant number of tumours, and particularly precancer- ous conditions, grow so slowly – or do not develop at all – so it would be better to leave them be or to just actively monitor them.’ Multiparametric imaging makes it potentially possible to differentiate between aggressive and less aggres- sive tumours without a needle biop- sy. The detailed information about the type of tumour is, of course, not only of great importance for diagno- sis but also for treatment planning and monitoring. ‘As with all these procedures, a lot of ground work is needed,’ warns Baltzer. ‘You have to identify these procedures, test them, check their reliability and then vali- date them.’ In 2008, Dr Fabian Kiessling became W3-Professor for Experimental Molecular Imaging at the RWTH Aachen. A recog- nised speaker from the Working Group on Methodology and Research at the German Röntgen Society (DRG) he has been a member of the European Society for Radiology (ESR) Research Board since 2011. In 2015 chaired the ESR Molecular Imaging Subcommittee. In 2014 and 2015 he also co-chaired the European Society for Molecular Imaging (ESMI) Congress and he will be Chairman of the World Molecular Imaging Congress (WMIC) in 2016. Multiparametric examination of the breast in a breast cancer patient; the tumour becomes visible on the diffusion image (ADC – Apparent Diffusion Coefficient, DWI – Diffusion Weighted Imaging) with low signal intensity and high signal intensity respectively, due to its changed microstructure compared to healthy tissue. The direction coded diffusion images (DTI – Diffusion Tumour Imaging, here fractional anisotropy, direction of diffusion as well as colour coded visualisation of the diffusion direction in green = diffusion in the direction of the nipple) show the destruction of the normal microanatomy of the breast caused by the tumour. The perfusion map shows the increased perfusion typical of tumours. The conventional T-2-weighted (T-2w) image on the other hand provides little functional information. screen. Additionally, the screen offers the latest anti-glare coating, minimising distracting ambient light reflections, and providing the high- est level of ergonomic comfort,’ NEC Medical Solutions adds. Connectivity The display offers flexible inputs including two DisplayPort, two DVI-D and four HDMI video inter- faces. Additionally, an extension slot at the rear conforms to the OPS form factor, for an optional HD-SDI 3G video converter. ‘Combined with one of NEC’s 4K UHD Large Format Display X UHD Series, the MD322C8 delivers a powerful MDT/PACS Demo Room solution. Together, the two 4K UHD screens can be cloned on a pixel to pixel level to the highest image quality without any loss of data or visual detail.’ NEC displays are suited to com- puter tomography, magnetic reso- nance, nuclear medicine, interven- tional radiology, PET, mammogra- phy and digital radiology as well as surgery. Further details: www.medical.nec-display-solutions.com the VEGFR-2-Receptor with a further measurement. ‘In the differentiation of breast cancer we could show that molecular information is clearly superior to functional information. This is very promising and we are working very hard on the develop- ment of the clinical implementation of this procedure.’ Associate Professor Dr Pascal Baltzer, from the Clinic for Radiology and Nuclear Medicine, Medical University of Vienna, Austria

EH 3_2015

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