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AN EVENT AN ORGANISATION parishealthcareweek.com 2 4 > 2 6 M A y 2 0 1 6 PARIS - PORTE DE VERSAILLES - PAVILLON 1 M E E T T H E F R E N C H H O S P I TA L K E Y P L A Y E R S I N P A R I S www.healthcare-in-europe.com 23ULTRASOUND for use with contrast, and visual- ise vascular patterns, long after the bolus injection, he explained. ‘It is important for the detailed diagnosis to see how vessels grow into the tumour and to visualise exactly the vascular tree of the tumour, which is now also possible in 3-D technology with SMI.’ Meanwhile, half a world away at the Royal Melbourne Hospital in Australia, Robert Gibson MD finds Version 6 enhancement on the Aplio platform to be refined SMI and sim- plified its use with filter controls, which, he said, ‘should prove a real clinical advance in displaying small vessel flow and vascular morphol- ogy.’ Shear-wave elastography An essential innovation of the Aplio Platinum series was the introduction of the shear-wave elastography with propagation mode, also making it possible to visualise the propaga- tion of the shear-wave generated in the tissue as a colour-coded image, while simultaneously measuring the absolute value of elasticity in a cho- sen region. ‘Having these available in twin view allows a greater degree of confidence in selecting reliable regions of interest for elastogra- phy measurement,’ Gibson said. Elastography mapping in general has been enhanced with the Version 6 upgrades to the Aplio platform, he added, with propagation map cleaner than ever. ‘The Aplio 500 can indicate wheth- er an elasticity measurement was successful, or not, because of the propagation mode, and the new version has even further improved this,’ Fischer said. ‘The examina- tion procedure used to be a case of guessing the region of interest in a certain section of the image, start- ing the measurements and hoping that shear-wave signals were actually being measured. Now we can actu- ally see whether or not the quality of the shear-wave propagation is adequate and then measure where propagation lines occur most evenly within the region of interest.’ ‘This enhanced functionality car- ries clinical impact,’ he pointed out. ‘It will lead to long-term changes for the diagnosis of liver disease. Whilst it is possible to diagnose fibrosis with the help of a biopsy, shear- wave measurements can document much larger sections of the organ. To me this makes more sense than examining just a small sample.’ Fusion imaging and real- time 3-D needle tracking Three rooms are equipped for inter- ventional radiology at the University Hospital of Strasbourg in France and, according to the department chairman Afshin Gangi MD, ‘They are packed with patients, completely full, because we are asked to do so many interventions. ‘The majority of our cases are for biopsies, but patients are lined up for ablations, as well.’ When the upgraded needle-tracking capabil- ity arrived for the Aplio Platinum system, ‘it was like adding a fourth room for biopsies and interventions,’ he said. ‘Once I have the image fusion and know where the tumour is situated, I can do the intervention anywhere I can correctly position a patient. With the Toshiba Aplio plat- form, I don’t have to wait for the CT or the MR room to be open.’ Additionally, he pointed out, ‘The needle-tracking function is excellent, giving an ability to truly project the path for the needle into the lesion, and then keeping clinicians on-track, even where the actual needle cannot be visualised by ultrasound because of bone structures or body fat. ‘The system shows exactly where the tip of that needle is and, even better, tells me if I am too high or too low. We can achieve far greater precision during biopsies now – more precise every time. With the help of image fusion and needle navigation we can now use ultra- sound guidance for applications we would never have considered before, such as with bone or the chest wall.’ The ease-of-use and accuracy of the enhanced image fusion software has also affected clinical routine and accelerated patient throughput, Gangi explained: ‘Today the tech- nicians can do this so that when the interventionalist comes into the room, it’s done. This saves a lot of time, and I can tell you this is very important for us.’ erb Microvascular nd more… CEUS image of a haemangioma after 15s. Tbe use of SMI to visualise vascularisation with contrast agent after 1:12 minutes. The characteristic vascular pattern can be viewed at any point after the administration of contrast agent without the need for a new bolus administration Lung biopsy with thoracic contact to rule out malignancy: Smart Fusion allows the interventionist to find the lung lesion attached to the pleura easily – and even the smaller ones. The needle navigation improves his depth targeting confidence and makes the biopsy safer for the patient 50-year-old patient has Hepatitis C and histologically confirmed stage three fibrosis. Shear-wave propagation on the left image. The ROI is determined within the area outside the vessels, which is free of artefacts and is simultaneously visualised on the B-image on the right to standardise the measurement Bone biopsy in a humerus fracture to exclude a bone metastasis: Smart Fusion allows the interventionist to find the region of interest easily, which would not have been possible without this system. Needle Navigation gives an extremely precise depth control even after entering the bone surface In 2007, Thomas Fischer became Head of Ultrasound Diagnostics at the Institute for Radiology at the Charité Berlin. Some two years later he founded the Ultrasound Research Laboratory there. The lab, of which he is still manager, focuses on studies into new ultrasound procedures and technologies Afshin Gangi, M.D., is head of the department of Interventional Radiology at the Hospital of Strasbourg in France. He received his education in the International French School of Teheran, graduating in 1980. During the summer of 1980, he attended medical school at the University of Reims in France, receiving his Degree in 1987. He began his residency in Strasbourg in 1987, first in the intensive care unit of Pneumology where he became excited about imaging and moved to the imaging department. Source:ThomasFischer Source:AfshinGangi 24 > 26 M A y 2016

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