ECR_2016

EUROPEAN HOSPITAL  Vol 25 Issue 1/16 12 EH @ ECR PET imaging enhances dementia understanding Making data management intelligent and stress-free Visualising amyloid deposition Coming your way: Vendor neutral archives Report: Mark Nicholls Neurologists are gaining new insights into dementia imaging by harness- ing the latest opportunities offered by Positron Emission Tomography (PET). In a session at ECR 2016, Professor Karl Herholz will highlight how the modality is not only making an important contribution to enhancing diagnostic accuracy but also adding a new dimension to imaging demen- tia by helping to select patients for therapies at an earlier stage. As Professor of Clinical Neuroscience at the Wolfson Molecular Imaging Centre at the University of Manchester, UK, he will discuss latest developments in PET imaging in dementia in a session on that will also examine advances in other modalities in the imaging of the condition. Having conducted extensive research in this area, Professor Herholz will focus on recent devel- opments, outlining how advances in brain imaging have transformed the way clinicians think about, under- stand, and characterise Alzheimer’s and other dementias. ‘Among these, amyloid imaging has moved rapidly from a highly select carbon-based research tool, Vendor Neutral Archives (VNA) will become an integral part of every hospital in the near future. So what’s a VNA? In short, a medical imaging technology in which images, docu- ments and potentially any file are stored in a standard format with standard interfaces that enable other systems – independent of their ven- dor – to access it. At the 2015 Healthcare Information and Management Systems Society (HIMSS) convention, that acronym could be heard in educational ses- sions and around the exhibition – as it will no doubt be again at the end of this February and early March in Las Vegas. Infinitt’s VNA, the Infinitt Health­ care Platform (IHP), is not just an average vendor neutral enter- prise storage solution, the manufac- turer point out. ‘It not only archives, manages and distributes, but also allows users to share all DICOM and non-DICOM data, including audio, video, and document files. Also, as the IHP complies with major indus- try and security standards, such as HIPPA, HL7, IHE, its integration into other systems becomes easy. ‘Furthermore, it supports RESTful APIs and open APIs, making data integration from other systems pos- sible.’ Does that mean the IHP takes over all existing systems, such as depart- mental PACS, costing the hospital previous financial and technology investments? ‘No,’ the firm reports. ‘Instead, the IHP integrates with any major hospital systems including EMR, making cross-departmental and cross-enterprise referrals much easier. ‘Moreover, the IHP maximises data management efficiency and reduces overall cost, by support- ing intelligent Information Lifecycle Management (ILM). ILM refers to a wide-ranging set of strategies, from removing unnecessary studies automatically, based on configur- able rules for moving and deleting data, over exceptions (exception conditions setting) to real-time sys- tem monitoring.’ Another advantage of the IHP is an accompanying zero- footprint viewer (Universal Viewer, ULite) where both DICOM and non- DICOM data can be viewed. ‘This patient-centric viewer allows you to see a comprehensive view of each patient, helping you to have bet- ter clinical insights,’ the company points out. ‘All together, the IHP will make medical data sharing and collaboration easier, removing PACS and storage migrations needs in the future, eventually cutting IT man- agement costs and profiting you with a smoother workflow and full data ownership.’ Optimising radiological procedures X-rays used in medical diagnosis and treatment became daily routine. ‘Although the methods have become more precise and medical devices achieve better results with even smaller amount of radiation dose, a certain exposure to the patient is inevitable. Taken this into account, the most basic guideline of medical radiation protection, the ALARA- principle (As Low As Reasonable Achievable) is always followed,’ Infinitt reports. ‘To achieve con- tinuous improvements of image quality while reducing radiation dose, specific management systems are required that provide the rel- evant information and assistance. According to the implementation plans of the EURATOM Directive into national laws (e.g. X-ray Radiation Protection Regulation), a dose man- agement system will be an integral part of the legal requirements.’ Infinitt DoseM is a modality and vendor independent, web-based portal solution for management sup- port and quality assurance optimisa- tion. The system provides available only in centres with cyclo- trons, to full commercialisation, with three fluorinated amyloid PET trac- ers (florbetapir, florbetaben, and flutemetamol),’ he explained. Amyloid deposition a common feature of Alzheimer’s and effective amyloid imaging – via PET scanning - is being recognised and will permit earlier detection and intervention. Professor Herholz believes the ability to more directly visualise, in vivo, aspects of pathology in the brain - in this case amyloid deposi- tion, which was previously only possible at autopsy - represents a significant step forward. All three amyloid imaging ligands have been tested in well-conduct- ed, blind studies and all demon- strate a robust correlation with brain amyloid deposition, he added. ‘The development of amyloid imag- ing represents an important step change in our ability to characterise and assess patients with cognitive impairment and dementia.’ While suggesting there are clini- cal situations where it promises to make an important contribution to enhancing diagnostic accuracy, he believes the real advance of amyloid imaging is not just about improving diagnoses, but ‘about appropriately selecting subjects at an early stage for disease-modifying therapies. ‘In addition, as part of a wider biological profiling of a complex disease, it promises to drive for- wards new ways of understanding and classifying the dementia,’ he said. In addition to the role of PET in dementia imaging, other modali- ties and developments in imaging dementia will be highlighted. Professor Frederik Barkhof, Consultant Neuro-Radiologist, Professor of Neuroradiology and Scientific Director of the Image Analysis Centre at the VU University Medical Centre in Amsterdam, will discuss ‘MR contribution to diagno- sis and differential diagnosis’ and Sebastiaan Engelborghs, Professor of Neurosciences-neurochemistry at the University of Antwerp, will focus on ‘The neurochemistry of the Alzheimer’s continuum.’ ECR 2016 Sunday 6 March 8:30–10:00 am. Room G Imaging in dementia Karl Herholz is Professor of Clinical Neuroscience and head of Neuroscience Research at the Wolfson Molecular Imaging Centre, University of Manchester. Also an honorary neurological consultant at Salford Royal Hospital and honorary consultant at the Nuclear Medicine Department, Central Manchester Foundation Trust, he is a fellow of the Royal College of Physicians and the Royal Society of Medicine. He graduated in medicine at the University of Erlangen in Germany in 1980, and later became professor of neurology at the University of Cologne before moving to Manchester in 2005. His research interests include neuro-imaging studies (PET and MRI) of dementia and brain tumours. Data Management using the Infinitt Healthcare Platform (IHP) Infinitt DoseM Workflow With positron emission tomography (PET), radiologists can now detect human brain β-amyloid plaques, one of the pathological features of Alzheimer disease

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