ECR_2016

EUROPEAN HOSPITAL  Vol 25 Issue 1/16 14 EH @ ECR Zone acquisition and channel data processing deliver new-wave ultrasound Emergency care depends on standards and experience Rewarding China-USA research Keep it simple and straightforward Report: John Brosky If you are taking note of any break- through in ultrasound, here are two names you will want to put at the top of your ECR 2016 notebook: Resona 7 and ZONE Sonography Tech­nology. For short, you can jot down ZST and then add ‘plus’, or simply ZST+ because, with the new Resona 7 system, Mindray has combined revo- lutionary zone acquisition and chan- nel data processing with a bundle of advanced imaging functions to cre- ate a premium ultrasound platform. Putting it all together, ZST+ pow- ering the Resona 7 means that Mindray delivers more valuable tools for clinical imaging, placing this new premium system on the leading edge of a new wave of inno- vation for ultrasound. Deconstructing the innovation on- board the platform, the fundamental difference in image acquisition is that Resona 7 transforms ultrasound metrics from the conventional sig- nal processing technique of beam- forming to a channel data based processing that is faster. By transmitting and receiving a relatively smaller number of large zones, this unique capability ena- bles Advanced Acoustic Acquisition that extracts more information from each acquisition, 10 times faster than a conventional line-by-line beam-forming method. Mindray is also able to add Dynamic Pixel Focusing technol- ogy that allows the Resona 7 system to achieve an extreme uniform- ity in pixel level across the entire field of view, eliminating a need to adjust the focal positions in order to achieve uniformity across patient examinations. Enhanced channel data process- ing means the Resona 7 system- greatly improves imaging clarity through multiple and retrospective processing, and it means the plat- form is able to intelligently choose the optimal sound speed to improve image accuracy greatly, even where there are variations in tissue, allow- ing for adaptive tissue-specific opti- misation. Exclusive functions on the Resona 7 system include Vector Flow with vivid, accurate, and angle-inde- pendent visualisation of complex vascular haemodynamics profiles at the speed of up to 600 frames per second, and Smart Planes with fully automatic and accurate detection of the most significant foetal CNS planes and frequently used meas- urements to enhance diagnostic throughput and reduce dependency Report: Sascha Keutel What would constitute a typical emer- gency case? The first thing most people think of is trauma, particu- larly polytrauma, explains Professor Stefan Wirth. ‘Depending on the situ- ation, however, pulmonary embo- lism, acute abdomen, stroke, myo- cardial infarction and acute, meaning large internal or external haemor- rhages, are typical cases. We have about 500 “real” polytrauma patients each year. Including the other serious and urgent emergency cases, we see more than 5,000 patients per year. If we add the less urgent emergency cases and those that need exclu- sion, such as cerebral haemorrhage, the number of patients increases to 25,000.’ A typical diagnostic check-up for trauma ‘Generally speaking, trauma patients are patients who suffered accidents of any kind, but not every trau- ma patient is an emergency case. Therefore, there are different rou- tines. Ultrasound is very well suited to evaluate many musculoskeletal issues. While fractures are usually visualised in radiography, for some of them, such as spinal, elbow, pelvis or knee fractures, CT is not infrequently the better modality. Obviously each individual case requires a patient-ori- ented decision, taking into account issues such as radiation exposure. ‘Actually, the diagnostic workup for polytrauma patients is pretty straightforward: The first step is the decision as to whether indeed we are dealing with a polytrauma patient, meaning a patient with acute and most likely life-threatening injuries. Simply sending the patient to the shock room won’t suffice. In a facility with the appropriate infrastructure – building and organisation – the severely injured patient immediately – meaning during patient handover undressing and initial stabilisation – undergoes a so-called eFAST. The aim of this extended focused assess- ment with ultrasound for trauma is to identify within 30 to 60 seconds intra-abdominal free fluid, haemo- peritoneum or pleural effusion. An experienced physician will also be able to recognise pneumothorax dur- ing the eFAST. In all other cases immediate standardised whole-body CT is recommended. ‘In our hospital we use the shock room simply as transit room, so to speak, and take the patient straight to the CT table. Thus we save time and in an emergency, every minute counts. ‘I recommend positioning the patient feet forward into the CT gan- try and folding the arms across the abdomen. This is easy to standardise, avoids cable clutter in the gantry, provides easy access to the head for any type of anaesthesia and spreads the artefact the upper extremities present across thorax and abdomen. Then we do a quick CT scout scan that shows all relevant pathologies as clearly as an X-ray scan, but is performed much faster. Moreover, the scout scan shows whether the standard protocol can be followed or whether a different route is prefer- able, for example in arterial and/or urography phase with pelvic injuries, or expanding the scan to the proxi- mal femur if a serious femur fracture is involved. ‘Surprisingly, there is no guideline regarding the CT workup. Whilst only head, neck, thorax and abdomen scans are mandatory, there is evi- dence that whole-body CT increases patient survival rate. Therefore, I rec- ommend unenhanced CCT, followed by neck/thorax/upper abdomen in arterial and the entire abdomen in portal venous phase.’ Professor Stefan Wirth MBA EDIR, studied medicine and informatics at the Technical University Munich and Ludwig Maximilian University (LMU) Munich (1988- 98). He also holds an MBA from Munich Business School, a European Diploma in Radiology (EDIR) and is Managing Consultant at the Institute of Clinical Radiology at the LMU Hospital. He has also served as President Elect of the European Society of Emergency Radiology since 2015 to become President in 2017. Emergency medicine requires smooth, patient-oriented and perfectly timed cooperation of several clinical disciplines. ‘Today, radiology is much more than a service provider. In emergency medicine we are an integrated and active component of the diagnostic process – and beyond’, says Professor Stefan Wirth, Managing Consultant at the Institute of Clinical Radiology, Ludwig Maximilian University Hospital, Munich Diffuse Axonal Injury (DAI). Top: unenhanced CCT, axial; bottom: MRI 1T Polytrauma CT: root of the lung completely severed, right, massive haemorrhaging, lethal outcome Aortic rupture with haemothorax. CT: thorax with traumatic aortic rupture in typical location (isthmus) and haemothorax, density approx. 60 HU Traumatic pancreatic rupture. Left: CT. Right: MRI confirmation Traumatic disc prolapse 5/6 with secondary neurology CEUS of MLC: CEUS shows MLC with excellent uniformity high penetration more than 16cm in contrast imaging V Flow of Carotid Bulb and JV: V Flow presents simultaneous and instant blood flow of jugular vein and carotid artery bifurcation

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