ihe_feb09

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Post-a-comment on feature articles: see inside

New!

MEDICAL IMAGING SPECIALImaging of acute stroke patients

Also in this issue:

Hospital medical emergency teams: pros and consPain and activity monitoring in joint replacement patientsRFID systems for managing hospital equipment

Portable spirometer - Page 31

Real-time UltraSound merged with CT, MR and PET - Page 20

THE MAGAzINE FoR HEALTHCARE DECISIoN MAkERS

Volume 35 Issue 1IHE February-March 2009

Compact yet powerful ultrasound

system - Page 22

IHE_7500 Ad.indd 1 2/11/2009 3:52:22 PM www.ihe-online.com & search 45161

EdItor’s LEttEr – Issue N°1 – Feb/March 20093

One of the most impressive exam-ples of calm and efficiency under extreme pressure was the recent safe emergency land-

ing of a US air jet plane with more than 150 passengers aboard, on the Hudson river in New York City. Only a few minutes after having taken off from La Guardia the airliner struck a flock of geese whose impact disabled both engines of the two-engined plane. In literally only a few min-utes time critical decisions had to be taken, for example to assess the pos-sibility of refiring the engines and to evaluate the few alternative options available (return to the departure airport? — aim for an alternative airport?) before finally preparing for the option chosen, namely an extremely dangerous landing in the Hudson river. The fact that all this was achieved successfully with no loss of life was explained modestly by the pilot as simply (!) the result of putting into action procedures which had been well practised on simulators. In fact the only slightly frustrated note struck by the pilot was a couple of weeks after the event when he bemoaned the fact that he had not yet been able to return to active flying, since he was still being debriefed on all aspects of the dramatic incident. While there is a limit to the extent to which they can be drawn, there are undoubtedly parallels between flying a modern jet airliner and certain modern medical situations, or more particularly critical surgi-cal, interventions. Both flying and critical surgery generally involve sophisticated high tech instrumen-tation, unexpected developments can occur in both situations, and, crucially, human life can depend on the correct decision being taken. In both cases decisions have to be taken rapidly and without the luxury of a leisurely review of the situation. In the light of all this, several voices are being raised within the medical community advocat-ing the application of a briefing/debriefing system similar to that used in aviation. The aim of this is

to overcome the all-too pervasive mind-set within the medical com-munity of not being open to rec-ognising and learning from errors. Certain statutorily obligatory post-operative procedures have to be taken and minimal explana-tions given after operations result-ing in the death of the patient. However, in general, very few efforts are made after complicated

surgical interventions to carry out an extensive debriefing pro-cedure to determine whether, in future cases, different, or the same, courses of action should be taken.Pressure of work is often cited as justification for this paucity of briefing/debriefing, an argument unacceptable in aviation. The contrast with the aviation industry is marked. There may

indeed be lessons to be learned.

Comments on this article?

please feel free to post them atwww.ihe-online.com/comment/lessons

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ContentsFRONT COVER PRODUCTS[20] real-time Ultra-

sound merged with Ct, Mr and PEt

[22] Compact yet powerful ultrasound system

[31] Portable spirometer

For submission of editorial material, contact Alan Barclay at [email protected]

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CoMING UP IN APrIL/MAy 2009Anaesthesiology special Ct update Patient monitors

FEATURES[6 - 8] EMERgENCy MEDICINE[6 - 7] Hospital medical emergency teams (METs):

pros and cons

[8] Critical care news in brief

[10 - 23] MEDICAl IMAgINg SPECIAl[12] Evaluation of a wireless DR detector

[14 - 15] Lowering the radiation dose with obese patients

[16 - 19] Neuroimaging in stroke patients

[20 - 23] Medical imaging product news

[24 - 25] ORThOPAEDICS Monitoring pain and activity in hip and knee replacement patients

[26 - 27] hOSPITAl MANAgEMENT Keeping track of portable hospital equipment

REgUlARS[3] Editor’s letter

[28 - 29] News in brief

[30 - 33] Product News

[34] Calendar of upcoming events

Weekly news updates on www.ihe-online.com

Post-a-comment on feature articles: see inside

New!

MEDICAL IMAGING SPECIALImaging of acute stroke patients

Also in this issue:

Hospital medical emergency teams: pros and consPain and activity monitoring in joint replacement patientsRFID systems for managing hospital equipment

Portable spirometer - Page 31

Real-time UltraSound merged with CT, MR and PET - Page 20

Real-time UltraSound Real-time UltraSound Real-time UltraSound Portable spirometer - Page 31spirometer - Page 31

THE MAGAZINE FOR HEALTHCARE DECISION MAKERS

Volume 35 Issue 1IHE February-March 2009

Compact yet powerful ultrasound

system - Page 22

Compact yet

Smit Röntgen, Hi-5™5 mm X-ray grid

Standard3 mm X-ray grid

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additional data, alternative points of view or simply questions

regarding the above article, please feel free to post them at

www.ihe-online.com/comment/

As part of IHE’s continuing policy of encouraging reader feedback, we are inviting our readers to post

comments, suggestions or questions on our website. At the foot of each feature article in each issue of IHE, you will find a specific IHE web address for comments relating to the article in question.

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6 – Issue N°1 – Feb/March 2009 EMErGENCy MEdICINE

The basic rationale for the creation of dedicated Medical Emergency Teams (METs) is to address the situation that can occur if a patient on a gen-eral ward develops critical illness and there are insufficient resources (both in terms of person-nel and equipment) to meet the clinical need. In response to these considerations, the concept of a Rapid Response System (RRS) has emerged. In addition to being known as MET, the respond-ing team can also be known as a rapid response team (RRT) or critical care outreach (CCO) but whatever the name, all are designed to provide early intervention by individuals with critical care competencies. The recommendations of an inter-national consensus conference on METs were that hospitals should implement a rapid response system, consisting of four elements [2]. These are an afferent, “crisis detection” and “response trig-gering” mechanism; an efferent, predetermined

rapid response team; a governance/administra-tive structure to supply and organise resources; and a mechanism to evaluate crisis antecedents and promote hospital process improvement to prevent future events.

The case for METS The rationale for a MET is both obvious and intuitive: the provision of a rapidly responding team should overcome the situation in many hospitals, where there are inevitable delays within a hierarchical structure that consists of individuals who may not possess the appro-priate skills for the treatment of deteriorating patients. With a MET, costs may thus be saved via a reduction in the length of ICU and hos-pital stays. Many studies have been set up to try to quantitate the benefits of the implementation of METs and some have demonstrated a positive

effect. However, from an evidence-based medi-cine point of view the level of evidence is fre-quently weak and most of these studies can be considered as Level 2 evidence at best, with a sig-nificant likelihood of bias. At least there does not seem to be any suggestion within the literature that METs are actually harmful in some way.

The case against METsOne of the most fundamental arguments against METs is that surprisingly there is no clear-cut evi-dence in favour of cardiac arrest team systems, which have served as the model on which most METs have been designed. The more detailed evi-dence against METs comes from a rigorous analy-sis of the studies that on the face of it purported to show benefits. The question being raised is simply this: are the data in such studies flawed to the extent that they cannot be trusted. For example, some studies involved the comparison of hospitals using the MET system with others that didn’t. Clearly differences between the basic case composition of the different hospitals could bias the results. A priori, the use of studies in the same hospital before and after the introduction of METs should minimise this problem, but even here problems still exist, such as seasonal varia-tions, differences in case mix and general changes with time of the overall health care provision.

Accepting the limitations of such “before and after studies”, two studies have shown that there is no demonstrable benefits to the introduction

No studies have yet shown conclusively that the implementation of Medical Emergency Teams is cost-effective.

typically composed of an ICU doctor, nurse and other appropriate personnel, Medical Emergency teams (MEts) were first introduced in certain hospitals in the 1990s. since then MEts have been widely implemented; their mission is to provide a medically-based critical care resource to critically ill patients wherever in the hospital it is needed. MEts should be able to be summoned to a medical emer-gency in a similar manner and with comparable urgency as a traditional cardiac arrest team. Although MEts seem on the surface to make intuitive common-sense, the data regarding their benefits are not clear-cut, and can even show them to be inefficacious. A recent paper by Price and Cuthbertson evaluated the cases for and against MEts [1]; this article presents their principal conclusions.

the pros and cons for having medical emergency teams (MEts) in hospitals

Key points for clinical practice as recommended by Price and Cuthbertson [1]1. The overall success of METS depends on

the individual components. Thus, the individual scoring system used to trigger the call for MET needs to be appropriately sensitive and specific and the team itself should of course be appropriate for their intervention.

2. Data so far suggest that METS are not efficacious. Future implementation of METs should only take place if and when the track and trigger systems are validated.

3. The failure to adequately measure cost-effectiveness of METS prior to widespread implementation may produce a reaction leading to disinvestment in the field.

– Issue N°1 – Feb/March 20097

of METs. In a UK study, Kenward et al [3] looked at the effect of the introduction of a MET on the inci-dence of cardiac arrest and in-hos-pital death. The study was carried out over a period of one year before and one year after the introduction of MET. For both outcome param-eters, no benefit was shown for the existence of METs.

The MERIT study (Medical Early Response. Intervention and Therapy) is the largest and most robust study of METS and involved 23 hospitals in a prospective cluster-randomised trial [4], with the primary outcome being the composite of unexpected death, cardiac arrest and unplanned ICU admission. The studies were designed such that for each hospital there was a baseline period of two months prior to the introduction of METs in the test group of hospitals. Of course, in the control group of hospitals, no METs were set up after the baseline period. It was found that a significant improvement in the outcomes between the baseline period and test only occurred in the control group of hospitals (i.e. those with no METs)! Direct comparison of the test and control hospitals showed no statistically significant improvement in those hospitals

using METs. Various theories have been advanced to explain the appar-ent lack of efficacy in the MERIT studies. One is that the triggers used to call the MET [Table 1} were not specific or sensitive enough. Likewise the use of a composite outcome cri-terion of unexpected death, cardiac arrest and unplanned ICU admis-sion may have been inappropriate. Other explanations could be inap-propriate staffing or inappropriate or inadequate interventions. How-ever until clear evidence for the ben-efits of METs is presented, the case

for their implementation remains seriously flawed. References 1. Price RJ and Cuthbertson BH. Should

hosiptals have a medical emergency

team? in Controversies in Inten-

sive Care medicine ed by Kuhlen R,

Moreno R, Ranieri M and Rhodes A,

pub by Medizinisch Wissenshftliche

Verlagsgesellschaft 2008

2. DeVita MA et al. Findings of the first

consensus conference on medical

emergency teams Crit Care Med 2006;

34: 2463.

3. Kenward G et al. Evaluation of

a Medical Emergency Team one

yearafter implementation.

Resuscitation:; 2004: 61: 257.

4. Hillman K et al. Introduction

of the medical emergency team

(MET) system: a cluster-ran-

domised controlled trial. Lancet

2005; 365:2091.

Table 1. Typical example of a MET scoring system.This one was used in the MERIT study which involved 12 hospitals

in Australia that had implemented METs compared with 11 that had not. The interpretation of the findings was that the MET system greatly increased

emergency team calling, but did not substantially affect the incidence of cardiac arrest, unplanned ICU

admissions, or unexpected death [2].


please feel free to post them atwww.ihe-online.com/comment/MET

154x206IHE 1 08.10.24 3:42:28 PM


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New!

THE MAGAzINE FoR HEALTHCARE DEC Is IoN MAkERs

– Issue N°1 – Feb/March 20099CrItICAL CArE NEWs IN BrIEF

Constant compressions critical to CPRInterrupting chest compressions dur-ing resuscitation reduces the chances of heartbeat return after defibrillation. New research pub-lished in the open access journal BMC Medicine shows that for every sec-ond of a pause in

compressions there is a 1% reduction in the likelihood of success.Kenneth Gundersen from the University of Stavanger, Norway, worked with a team of researchers to quantify the effect of compres-sion interruptions on the probability of a return of spontaneous circulation (ROSC). He reported that the researchers analysed data from 911 interruptions and found that every second without the blood perfusion generated by chest compressions had a negative impact on the estimated probability of ROSC.The American Heart Association’s first aid guidelines were updated last year, suggesting that the ‘mouth-to-mouth’ component of CPR was unnecessary. This new research supports that position, in that the pause in compres-sions required to perform artificial respiration may reduce the patient’s chances of recovering a heartbeat.Gundersen said that the first priority when witnessing a cardiac arrest was to make an emergency call. Beyond that, the team’s results showed that performing powerful chest com-pressions with minimal interruptions was of utmost importance. The message is that the quality of CPR matters and everyone should practice their CPR skills at regular intervals.http://www.biomedcentral.com/bmcmed/

Laparoscopic surgery for acute appendicitis increases costs and complications

New research published in the February issue of the Journal of the American College of Surgeons suggests that a traditional, “open” appendectomy may be preferable to a less-invasive laparoscopic appendectomy for the majority of patients with acute appendicitis, contrary to recent trends. Appendectomies to treat appendicitis are con-sidered a medical emergency. If treatment is

delayed, the appendix can rupture, causing infection and even death. For almost a century, open appendectomy was the standard treat-ment for appendicitis, until the 1980s when laparoscopic appendectomy first gained popu-larity. This transition was based on data that suggested the operation, in which a laparoscope is inserted through small incisions in the abdo-men, was associated with reduced pain, faster recovery and better cosmetic results. This retrospective study examined 235,473 patients who underwent open or laparo-scopic appendectomy between 2000 and 2005. Length-of-stay, costs and complications were assessed by stratified analysis for uncompli-cated (n=169,094) and complicated (n=66,379) appendicitis. Regression methods were used to adjust for covariates and to detect trends.The study demonstrated that the odds of hav-ing any kind of complication were signifi-cantly higher in the laparoscopic group among patients with uncomplicated appendicitis (p<0.05, odds ratio = 1.07), and that there was no difference among patients with complicated appendicitis (p=0.74). The only complications reduced by using the laparoscopic approach were infections in the uncomplicated group, and infections and pulmonary complications in the complicated group. The adjusted costs for laparoscopic appendec-tomy were 22 percent higher in uncomplicated appendicitis and 9 percent higher in patients with complicated appendicitis (p<0.001). The increased expense for laparoscopic appendec-tomy are most likely related to higher operating room costs, including greater expense for opera-tive instruments and longer operative times. According to the study, laparoscopic appendec-tomy did result in a reduced length of hospital stay for both the uncomplicated and complicated groups (p<0.001 and p<0.0001, respectively). http://www.journalacs.org/article/ S1072-7515(08)01540-8/

Stent placement should be determined by arterial blood flow measurementReperfusion therapy in the form of percutane-ous coronary intervention (PCI) is now the rec-ommended first treatment for victims of acute myocardial infarction. New European guidelines issued in November 2008 emphasised speed of action and the importance of reperfusion therapy to restore blood flow to the heart and improve survival rates. The cornerstone of PCI is the technique of angi-oplasty, by which either bare-metal or drug-releas-ing stents are located within the coronary arteries at points of occlusion. The FAME study, reported in the 15 January issue of the New England Jour-nal of Medicine, was a randomised trial designed to assess the most effective method of locating the stent in patients with multivessel disease. These are respectively conventional angiography (visualisation of the artery) or a new technique

of “fractional flow reserve” (FFR), in which a tiny wire with a sensor is threaded through the coro-nary artery to the point of occlusion and blood flow is measured to determine if the lesion is restricting blood flow and causing ischaemia.The study, conducted in 20 European and US cen-tres, randomised more than 1000 patients with multivessel coronary disease to either of the two methods for placement of stents. Results showed that one-third fewer stents were used in the FFR group and the difference in composite outcome at one year was significant: the FFR group showed a relative 28% lower incidence of major adverse cardiac events (repeat angioplasty, heart attack or death) - 18.3% vs. 13.2%. The implication in these results is that placing stents in lesions not responsible for ischaemia is not only unnecessary, but may cause worse outcomes.

http://content.nejm.org/cgi/content/full/360/3/292

ARDS mortality unchanged since 1994Mortality in patients with acute respiratory distress syndrome (ARDS) has not fallen since 1994, according to a comprehensive review of major studies that assessed ARDS deaths. This disappointing finding contradicts the com-mon wisdom that ARDS mortality has been in steady decline. The study was published in the February issue of the American Journal of Respiratory and Critical Care Medicine. The authors reviewed all prospective obser-vational and randomised controlled trials between 1984 and 2006 that included more than 50 ARDS/ALI patients and reported mortality. Contrary to the suggested benchmark mortal-ity of all ARDS and related acute lung injury (ALI) cases being 25-30 percent, the authors state that their findings suggest a benchmark mortality of 40- 45 percent. The results high-light the need for future effective therapeutic interventions for this highly lethal syndrome.

http://ajrccm.atsjournals.org/cgi/content/full/179/3/220

Evaluation of a wireless DR detector

Page 12

Lowering the radiation dose with

obese patientsPage 14 - 15

Neuroimaging in stroke patientsPage 16 - 19

A selection of the latest products in the medical imaging field

Page 20 - 23

Reducing the dose in CT:the constant challenge

Feb/March 2009

Medical imaging Special

One of the paradoxes of computed tom-ography X-ray scanning (CT) is that its very success has resulted in a net increase of the quantity of ionising radiation to which both patients (and perhaps more worryingly) asymptomatic subjects are being exposed.

In the radiology field as a whole, while there are of course variations between countries, regions and even between hospitals in the same country, the over-all trendlines are inexorable. The total number of examinations being carried out involving X-rays in one form or another is more or less constant. The number of standard radiographs being taken is also more or less constant but there is a significant and steady decrease in the number X-ray examinations being carried using fluoroscopy. This decline in fluoroscopy is being compensated by a huge increase in the number of CT examinations being carried out.

By its very nature, the radiation doses used in CT examinations are significantly greater than those used in other radio-logical procedures, although, as pointed out by Brenner and Hall in their seminal New England Journal of Medicine paper (N Engl J Med 2008; 29;357(22); 2277-84), this is typically not fully (or even not at all) appreciated by most radiologists.

The result is that for the first time, the cumulative burden of ionising radia-tion generated by medically adminis-tered examinations is greater than that to which we are exposed from natural sources. (How many unnecessary or “just to make sure” repeated scans must have been mentally justified by radiologists through the thought that, after all the

ionising radiation involved is less than that received in a trans-atlantic flight?).

No-one disagrees with the recommen-dation that, whenever possible, an alter-native imaging modality such as ultra-sound or MRI that does not involve ionising radiation should be used instead of CT. The fact is however that the CT image quality and availability of systems means that CT looks set to remain the dominant routine imaging modality for the foreseeable future.

The good news in all this is that the major companies that manufacture CT equip-ment are not only well aware of the dose issue but are responding to the challenge of dose reduction through the innovative use of technology. The move to multislice sys-tems (MSCT), by its very nature means that at least one source of unnecessary radia-tion (that located in the penumbra region) is proportionally significantly reduced.

The very latest single dose dual energy CT system such as the Somatom Definition Flash from Siemens had dose reduction as its main design criterion. Incorporating several technological innovations includ-ing an increased rotation speed, the dose reduction that can be achieved with the system means that sub-mSv cardiac scans are now perfectly possible.

Technological advances are however only part of the answer to dose reduction. Ultimately it is up to the radiologist to justify the risk/benefit ratio of using the technology on his/her patients.

...the major companies that manufacture CT equipment

are not only well aware of the dose issue but are responding

to the challenge of dose reduction through innovative

use of technology...

...It has been estimated that one third of all CT scans are not justified by strict medical need,

so literally millions of patients are being irradiated unnecessarily...

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12 – Issue N°1 – Feb/March 2009

Q: For how long have you been using the DRX-1 system ?

A: We decided to evaluate the new system in two phases, first by carrying out a purely tech-nical and scientific evaluation of the system; only when we had satisfactory results in this phase would we begin real use of the system in clinical cases. The first, purely technical evaluation of the system started in October of last year. By the end of December we were satis-fied that we could safely use the system for real-life cases. We thus now have approximately one month’s experience in this second phase. With the high work-load in our department, this means that we already have quite a large “hands-on” experience.

Q: Your department already has an impressive list of radiology systems from various different vendors. Did your staff have any problems getting used to the new system or have a long “learning curve”?

A: Not at all. The staff had no particular problems getting used to the new system. Of course, in this respect it helps that the system itself is very user-friendly to operate. Our staff are now well-trained on the new system and are well adapted to it.

Q: How about the clinical quality of the results ?

A: That’s an easy question to answer. The overall impression of the system is absolutely outstanding. Of course from a clinician’s point of view one of the most important aspects of

any system is the quality of the images it pro-duces. In this respect, we have no problems — the image quality is very good. In practice the data we collect from the DRX-1 are used in a comparison study with storage phosphor imaging.

Q: Apart from its ease of use and qual-ity of the results, another feature that Carestream claim about the new wire-less system is that it is easy to install and that no modifications are needed to existing X-ray systems. Users can con-tinue to use the Bucky with CR or film-based cassettes if desired. Was this true in your case?

A: Yes. The new system was installed very rapidly, with no facility modification being needed. And while it’s true that we could go back to using film-based cassettes, we find the advantage of the wireless functionality of the DRX-1 to be so great that we keep it in constant use.

MEDiCAL iMAgiNg

Prof. Thomas Vogl is director of the Department

of Diagnostic and Interventional Radiology of the University Hospital of Frankfurt where the new Carestream DRX-1 system has been under evaluation

for three months.

The new wireless cassette-sized DRX-1 detector from Carestream Health was launched to great acclaim by the radiology community at the end of last year.

At that time, the newly-launched system was still officially described as a “work in progress”. The DRX-1 is expected to be available in many parts of the world first half of 2009.

iHE decided to catch up with one of the first in-field evaluation test sites to see whether the potential of the new system was actually being realised in an every-day clinical environment.

We spoke to Prof. Thomas Vogl, M.D., Director of the Depart-ment of Diagnostic and interventional Radiology in the University Hospital of Frankfurt, germany.

Evaluation of a wireless DR detector system in a busy radiology department

The Department of Diagnostic and interventional Radiology,University Hospital Frankfurt.

Located in the centre of Germany, in the middle of the

Rhine-Main area, the University Hospital of Frankfurt

serves a population of one to two million people. One

of the largest in Europe, the hospital has 1500 beds

and has also a large throughput of outpatients. The

hospital covers all medical specialities.

As for the Department of Diagnostic and Inter-

ventional Radiology, it serves approximately 150

000 patients per year and offers all diagnostic and

interventional procedures. Currently the staff in

the radiology department numbers approximately

200 people, 30 of whom are clinical doctors or

medical assistants.

The department is extremely well-equipped and has,

among other modern instruments, one of the latest

CAT-scan systems that uses dual source technology, a

PET/CT system, a wide bore 1.5 Tesla MRI system, and

an Ultra high magnetic field MRI system (3 Tesla).

The new DRX-1 system

The innovative system features the world’s first wireless cassette-sized DR detector, which simply slides into the table or wall-stand Bucky. Alternatively, it can be used for table-top projections, just like a conventional cas-sette. After exposure, the 35 x 43 cm detector wirelessly transmits digital images to the sys-tem’s capture console for immediate viewing and manipulation. From the console, images can be quickly forwarded to a printer, PACS archive, or other network destinations. The detector’s light weight (3.9 kg) and wireless operation provide convenient handling—and unprecedented DR positioning flexibility.

Carestream HealtHrochester, NY, Usa www.ihe-online.com & search 45201

Frankfurt’s University Hospital is one of the largest in Europe


Obesity continues to be a public health con-cern in the United States and throughout the world. Recent studies published by the Cent-ers for Disease Control and Prevention in Atlanta, Georgia, show that more than one-third of US adults — over 72 million people — were classified as obese (Body Mass Index >30). While the situation in Europe is not (yet) quite as bad as in the US, worryingly, the European trend is inexorably upwards.

Obesity increases the risk of many diseases and health conditions including coronary heart disease, hypertension, type 2 diabetes, liver and gallbladder disease, osteoarthritis and sleep apnea [1, 2, 3].

Attaining detailed film-screen images of obese patients to diagnose disease remains a challenge for radiographers. X-ray imaging, especially of the abdominal region, is severely hampered by the presence of excess body tissue. To be able to penetrate the increased thickness, higher exposure settings are required. At higher kV, the penetrating power of X-ray increases, but the contrast between different parts of the body decreases. Also, the amount of scatter increases dramatically, which also hampers contrast [4].

Large patient exams are even more difficult with digital systems than film-screen because digital image capture is more sensitive to scatter radiation. While little can be done to

improve body part contrast, excess scatter can be successfully minimised with improvements to anti-scatter grids.

Radiographic imaging of large patients is com-promised by X-ray scatter. Optimisation of digital X-ray imaging systems used for pro-jection radiography requires the use of the best possible anti-scatter grids [5]. In projec-tion radiography, primary radiation from the X-ray source is captured by the image receptor and some radiation bounces off tissues and is redirected toward the receptor. This unwanted radiation is known as scatter, which is radiation that does not emanate from the X-ray source. Grids are designed to absorb the scatter radia-tion before it can reach the receptor but allow primary radiation to pass through [Figure 1]. Anti-scatter grids prevent unwanted radiation from reaching the image receptor, whether its film, image intensifiers, computed radiography or direct capture digital radiography [6].

Anti-scatter gridsAll grids are constructed with lamella consisting of a strip of lead and a strip of interspace mate-rial. Grids are differentiated by the interspace material (aluminum or fibre) used between the lead strips. Conventional grids use aluminum as the interspace while advanced grids use a fibre interspace material. Fibre material has less radiation attenuation, allowing better primary transmission. Fibre absorbs 20%-40% less pri-mary radiation than aluminum; this means imaging can be accomplished at 20%-40% reduced dose levels.

Dunlee, a division of Philips Healthcare, intro-duced the new Hi-5 line of Smit Röntgen grids at the 2008 Radiological Society of North America (RSNA). These grids are the first products designed to improve image quality

Figure 1. Anti-scatter grids play an important role in projection radiography by transmitting a majority of primary radiation and selectively rejecting scattered radiation. By allowing primary x-rays to be transmitted

and scattered x-rays to be absorbed in the grid, image contrast is significantly improved [7].

Figure 2. Larger patients inherently create more scatter. The increased height of 5mm versus 3mm

lamellae captures more scatter, and at the same time the fiber-interspacing allows more primary radiation

transmission to reach the image receptor.

Smit Röntgen, Hi-5™5 mm X-ray grid

Standard3 mm X-ray grid

MEDiCAL iMAgiNg

Medical imaging manufacturers are on an ongoing quest to improve image quality, reduce patient exam times and lower radiation doses. For average-sized patients, new digital imaging modalities offer many advantages over film-screen methods and are gaining worldwide acceptance. For obese patients, the benefits remain elusive, primarily due to the amount of radiation exposure necessary to penetrate the patient, the amount of scatter radiation that hampers image contrast and the increased incidence of retakes to establish a definitive diagnosis.

By Thomas T. Spees

Lowering the radiation dose with obese patients


while dramatically reducing dose for average as well as obese patients.

Advantages of the new gridsHi-5 grids are interspaced with fibre instead of aluminum, allowing better radiation transmission and less attenuation. This results in a lower dose for the patient. The grids are further optimised for better scatter reduction by utilising lamellae that are 5mm high versus the normal 3mm height in conventional grids [Figure 2]. In clinical evalu-ations conducted at leading healthcare facilities, studies have shown a dose reduction up to 20% in average-sized patients and approaching 40% in severely obese patients [5,6].

Although the new grids are 2mm thicker than conventional grids, great care has been taken in their design so that they can be easily retrofitted into existing imaging systems. Whether patients

are average size or grossly large, all radiographic modalities benefit from these fibre-interspaced grids, particularly in fluoroscopy, computed radiography (CR) and digital radiography (DR) applications. Clinical disciplines that are very con-scientious of dose, such as mammography and cardiology, primarily use fibre interspaced grids.

Conventional radiography has been slower to incorporate fibre grids into imaging systems. Concerns include replacement costs and a pre-sumption that existing equipment will have to be modified to incorporate new grids. In fact, the new grids are easily swapped into existing systems, requiring no special retrofit hardware. Although fibre grids are priced slightly higher than aluminum grids, the benefits of lower dose, adaptability to varying patient sizes and ability to enhance images make these grids well worth the replacement cost.

References1. www.cdc. gov/ncdphp/dnpa/obesity/trend/maps/2. www.cdc.gov/nchs/data/databriefs/db01.pdf3. www.cdc.gov/nchs/products/pubs/pubd/hestats/

obese/obse99.htm4. Kok C. Improving digital imaging quality for larger

patient sizes without compromise. Smit Röntgen, February 2008, pp.1-16.

5. Fetterly K, Schuler B. Experimental evaluation of fiber-interspaced anti-scatter grids for large patient imaging with digital x-ray systems. Physics in Medi-cine and Biology, Volume 52, Number 16, 21 August 2007, pp. 4863-4880.

6. Spees T, Nuijts P. Smit Röntgen grids for low-dose imaging. Radiological Society of North America, 2 December 2008, conference presentation, pp.1-17.

7. www.upstate.edu/radiology/rsna/radiography/scattergrid/

The authorThomas T. Spees, Director,Dunlee,555 North Commerce Street,Aurora, IL 60504 [email protected] www.ihe-online.com & search 45215

Dunlee and Smit Röntgen are divisions of Philips Healthcare

Comments on this article?Feel free to post them at

www.ihe-online.com/comment/Grids

Figure 3. Clinical studies completed at leading medical institutions showed dose rate reductions of 20%-40% using the new Hi-5 grids.

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Stroke is the third most frequent cause of mor-tality after ischaemic heart disease and cancer, and the primary cause of disability in adults worldwide. In 2005, there were an estimated 62 million stroke survivors. Over 15 million people suffer a stroke each year and of these, approximately five million will die as a result, and another five million will be permanently disabled. One of the most important chal-lenge facing physicians globally is to reduce the unacceptable burden of stroke.

Prompt differential diagnosis is essential, but achieving rapid imaging in the Emergency

Room (ER) is challenging, both for small com-munity hospitals and large academic centres. There are numerous, frequently-encountered clinical scenarios for which there is an urgent need to briskly transport patients to the radiol-ogy suite: suspected intracranial haemorrhage, pulmonary emboli or ruptured aneurysms. Delays in obtaining the appropriate diagnostic imaging study create delays in correct manage-ment. This is particularly significant for patients presenting to the ER with signs of acute stroke.

Thrombolytic, or “clot-busting,” drugs offer tremendous hope to stroke patients, breaking apart the clots that deprive the brain of oxygen, preventing symptoms from progressing from

transient to permanent. However, thrombo-lytic agents may be contraindicated in many patients. First and foremost, clinical guidelines dictate that thrombolytic drugs be adminis-tered within three hours of symptom onset. If administered after this three-hour window, the potential risks of bleeding complications tend to outweigh the benefits. For example, in about 83% of acute stroke patients their symptoms are secondary to a clot starving the brain of oxygen [1]. For the remaining 17% the stroke may be consequent to a site of haemorrhage in the brain [1]. In all such cases, administra-tion of a clot-busting drug will exacerbate the hemorrhage. It is crucial to rapidly image such patients and “triage” them accord-ingly: those with oxygen-depriving clots may indeed be candidates for thrombolytic drugs; haemorrhage within the brain is an absolute contraindication to such therapy.

Non-contrast CT imagingThe first step in the evaluation of acute stroke patients is to distinguish between patients whose symptoms are due to bleeding (haem-orrhagic stroke) and those patients presenting with stroke due to clots (ischaemic stroke). This can be achieved with non-contrast CT imaging [Figure 1a and 1b]. Within the few hours of the onset of a haemorrhagic stroke, the non-contrast CT scan will identify the presence of haemorrhage. These patients require close neurological monitoring and possible neurov-ascular/neurosurgical interventions to control the bleeding.

Figure 1. The first step in the evaluation of acute stroke patients is to distinguish between haemorrhagic stroke and ischaemic stroke. This can be achieved with non-contrast CT imaging.

Figure 2. The US National Institute of Nerological disorders (NINDS) urges that CT imaging be completed within 25 minutes of the arrival of the patient in the ER. The time necessary to transfer the patient to the central radiology department frequently means that this recommendation cannot be made. The use in the ER of a dedicated head/neck CT scanner, ready at a moment’s notice for an arriving patient, can significantly accelerate the taking of the

scan and the vital differential diagnosis between ischaemic and haemorrhagic strokes.

Stroke patients can respond well if rapid diagnosis is followed by prompt and appropriate therapy. For example in ischaemic stroke timely administration of thromobolytic or “clot-busting drugs” can prevent the progression of symptoms from transient to permanent. Delays in diagnosis can however lead to irrevers-ible cerebral damage. The principal diagnostic challenge in overall stroke management is to differentiate brain ischaemic attacks from haemorrhages and stroke-like disorders. While timely non-contrast CT imaging distinguishes between haemorrhagic and ischaemic stroke, many hospitals cannot offer con-tinuously available CT scanning in the radiology department. A dedicated, head/neck scanner in the ER facilitates rapid differential stroke diagnosis.

by Dr David B. Weinreb

Rapid neuroimaging of acute stroke patients

MEDiCAL iMAgiNg

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By comparison, within the first hours of an ischaemic stroke, non-contrast CT imaging may likely be completely normal: the clot is barricading the flow of oxygen-rich blood to the brain, but it is too early to see any changes in the brain apparent on CT imaging. Gener-ally, greater than 24 hours after the onset of symptoms, repeat CT imaging will demon-strate areas of low attenuation, corresponding to brain territory that has been deprived of blood flow.

Non-contrast CT imaging should there-fore be performed as briskly as possible in patients with suspected acute stroke. The

National Institute of Neurological Disorders and Stroke (NINDS) urges that CT imag-ing be completed within 25 minutes of the patient arriving in the ER; the images should be interpreted within 45 minutes [2]. For various reasons, compliance with these time guidelines may be more easily attained in large academic centres. Specifically, these larger institutions may have a stroke team consisting a specialised nurse and stroke neurologist on-call to evaluate patients in the ER. Additionally, the radiology depart-ment may have continuously available CT scanning in the ER, staffed around the clock by teams of technologists.

However, the situation may be quite differ-ent in smaller community hospitals, and such differences have constructed barriers to ideal care. First, many community hospitals may not have a CT scanner in the ER; their imag-ing facilities may be located in another building and, in many cases, off-site. Additionally, the CT department may not be staffed 24 hours a day. These obstacles to the “25-minutes to CT” guideline represents challenges facing smaller community hospitals. This is particularly and painfully relevant given that the overwhelming majority of stroke patients initially present to community hospital ERs.

Use of a dedicated head/neck CT scannerFirst, one creative solution is a dedicated head/neck CT scanner, stationed in the ER, ready at a moment’s notice for an arriving stroke patient. One manufacturer, Neuro-Logica Corporation in Massachusetts, has developed a light-weight (700-lb), portable 8-slice scanner [Figure 2]. Designed specifi-cally for head imaging, this scanner is stored in the ER, eliminating the need for stroke patients to be transported to the radiology suite. In many of the community hospitals where this novel scanner is currently oper-ating, it has helped clinicians achieve the “25-minute” guideline [3].

A recent investigation has explored the clinical utility of the portable CT scanner for ER patients [3]. The study was conducted in the 16-bed ER of Salem Hospital/North Shore Medical Center (Salem, Massachusetts). At Salem Hospital, it typically took 25-35 minutes from the time of initial arrival at the ER door until the CT scan was completed. This delay in transporting the patient to the radiology suite for CT imaging was one of the several factors that slowed the entire process of clinically assessing patients present-ing with an acute ischaemic stroke. Thus, inter-ventions were necessary to provide more rapid diagnostic imaging for ER patients.

MEDiCAL iMAgiNg

Book REViEWControversies in intensive care medicineEdited by R. Kuhlen, R. Moreno, M. Ranieri and A. Rhodes Published by MWV Medizinisch Wissenschaftliche Verlagsgesellschaft OHG (2008), 534pp, e64,95 The theme of last year’s congress of the European Society of Intensive Care (ESICM) ‘Controversies in intensive care medicine’ resulted in this book that reflects the themes of the conference. In recent years, many clinical interventions

in intensive care medicine have been based on clear scientific evidence. However, at least as many clinical interventions still remain the subject of controversy, either due to a lack of rigorous data or due to the existence of conflicting data. In this book, these controversies are discussed by experts of international renown in their respective fields. The goal is twofold: to provide us with a balanced and unbiased presentation of the subject, explaining the different ‘schools of thought’ relevant

to the controversy and to summarise the data with a clinically useful and valid recommendation for our practice. Virtually all fields of intensive care medicine are covered in more than 50 chapters dealing with controversies over treatment options in acute illness states, organising and providing care for acutely ill patients, as well as how to answer ethical questions arising in critical care medicine every day. Accounts by the leading international experts in intensive care medicine are organised in sections on acute respiratory failure, acute circulatory failure, acute kidney injury, sepsis and infection, neuro-intensive care, acute bleeding, organisational issues, surgical intensive care and trauma and adjunctive issues.This volume will be invaluable for nurses, physiotherapists and other allied healthcare professionals as well as physicians in intensive care medicine including anaesthesia and other discipline.

mWV OHGHeidelberg, Germany www.ihe-online.com & search 45214

Figure 3. «Request to CT Scan» times in stroke patients before and after the introduction of a dedicated head/neck scanner.It can be seen that significant reductions in request to scan times are achieved with the

use of the ER dedicated scanner.


Following the implementation of a dedicated scanner in the ER, these times was drastically reduced to less than 17 minutes; a large percent of ER stroke patients were imaged fewer than 12 minutes [Figure 3]. These preliminary results suggest that increasing the availability of CT in community or rural hospi-tals may have a tremendously posi-tive impact on the ability to these hospitals to more effectively care for acute stroke patients.

In summary, providing rapid diag-nostic imaging when and where it is needed the most is an enormous challenge. Nowhere is this challenge more apparent than in community hospitals, faced with the arrival of a stroke patient within the three hour period for thrombolytic interven-tions. The emergence of new tech-nologies is helping to surmount this challenge, though new approaches and strategies at the community level are still needed.

References 1. “What is a Stroke?” Published by the

American Stroke Association. Avail-

able on 10/05/2008 at www.stroke-

assocation.org.

2. Proceedings of a National Symposium

on Rapid Identification and Treat-

ment of Acute Stroke, National Insti-

tute of Health, December 12-13, 1996.

Bethesda, MD: National Institute of

Neurological Disorders and Stroke.

3. Weinreb, DB and Stahl JE. The

Introduction of a Portable CT Scan-

ner is Associated with a 68% reduc-

tion in Door-to-Scan Times in a

280-bed Community Hospital.” In

press, Radiology Management.

The authorDavid B. Weinreb, MDHospital of Saint RaphaelNew Haven, ConnecticutUnited States

Correspondence to: David B Weinreb, MD Apartment 5133, 100 Town Walk Drive Hamden, CT, USATel +1 917-833-9472


please feel free to post them atwww.ihe-online.com/comment/stroke_CT

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Portable CT Scanner The CereTom portable CT scanner is an 8-slice CT scanner that deliv-ers the highest quality non-contrast, angiography, contrast perfusion and xenon perfusion scans in every conceivable patient location. It is designed for use in the emergency room, operating room, intensive care units, interventional suite or any medical clinic. It is portable enough however to be able to be installed in ambulance. In the near future its capabilities will be expanded to facilitate use by orthopedic surgeons and dental spe-cialists. Its combination of rapid scan time, flexible settings and immedi-ate image viewing, make it an indispensable tool to any clinician needing real time data on critically ill patients.

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The Portable CT scanner is small enough even to be installed in an ambulance.

– Issue N°1 – Feb/March 2009 20 MEDiCAL iMAgiNg PRoDUCT NEWS

Radiography phantom

Also suitable for use with CR/DR systems, the Model 903 Radiography/Fluoroscopy QA Phan-tom can be used for initial QA assessment and routine monthly QA testing to help ensure that patients are receiving the best possible X-ray examinations. Manufactured from PMMA-equivalent epoxy, the Phantoms offer the same X-ray attenuation properties as acrylic but with significantly greater durability. The overall phantom measures 25 cm wide x 25 cm long x 20.7 cm high and consists of three attenuation plates, one test object plate and a detachable stand for easy, reproducible set-up. Test objects include high-resolution copper mesh targets from 12 – 80 lines per inch and two separate contrast-detail test objects. COmpUterized imaGiNG refereNCe sYstems, iNC.Norfolk, Va, Usa www.ihe-online.com & search 45197

Digital X-ray system

Featuring increased productivity and patient comfort while eliminating film, the Kalare R&F system combines a superior user interface and feature set with true all-digital imaging for fluor-oscopic and radiographic examinations. With its high-resolution, removable, flat panel detector, all digital images can be captured and displayed instantly on dedicated digital workstations. ln today’s healthcare environment, maximis-ing imaging resources and improving patient throughput is critical to success. This X-ray system helps medical centres to accomplish these goals while lowering costs and improving patient care. The system is specifically designed to accommodate the needs of busy facilities. lt allows clinicians flexibility to obtain images from virtually any position without moving the

patient thus providing improved comfort and faster exams. This makes it ideal for imaging ambulatory, wheelchair and stretcher patients. This flexibility also dramatically increases room utilisation and overall operational efficiency.

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MR flow analysisAn MR flow analysis functionality has been added to the CAAS MR product range. This software enables health professionals to per-form analysis of Phase Contrast Angiography MR images (PCA). Such images can be used for quantitative assessment of blood flow and veloc-ity. The software allows vessel edge detection and contour propagation, analysis of four Regions (ROIs) per series and anatomical designations for direct calculation of clinical results. An intui-tive user interface as well as reliable and repro-ducible segmentation are provided. Images from the major MRI scanner vendors are supported.

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Certified high resolution display

The Dome E4c system from NDS Surgical Imag-ing is a 4MP, medically certified, high-resolution display ideal for diagnostic review. The unit is a bezel-less, 30-inch (76 cm) display with a wide-screen, 16:9 format. Equivalent to two 2MP dis-plays, the E4c simplifies comparison studies by eliminating the bezel split and has the ability to show 15 full size 512X512 images at the same time. With a broad colour spectrum, the system provides the advantage of being able to view, on a single viewing station, various colour modali-ties such as PET/CT, fusion, ultrasound, CT and MR as well as 2-D colour imaging, image fusion and 3-D reconstruction. The display is ideal for use in the operating room, for the review of radi-ology images as well as the display of any other electronic medical record applications. The system is fully DICOM calibrated.

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Breast PET-guided biopsy featureDesigned for use with the company’s high-res-olution organ-specific PET scanner, the Stereo Navigator is a Positron Emission Mammogra-phy (PEM)-guided biopsy accessory, indicated for the localisation of lesions in female breasts as identified on a PET image. This guidance system enables physicians to guide compatible interventional devices towards abnormalities visible on PET. This biopsy feature represents the cutting edge of targeted molecular imaging

FRoNT CoVER PRoDUCTReal-time UltraSound merged with CT, MR and PET

Foremost among many new ultrasound products just introduced by GE Healthcare is the new Logiq E9 ultrasound system for radiology and vascular applications. The new system fuses ultrasound images with others from different imaging modalities such as CT and MR. The Logiq E9 features an innova-tive tool known as Volume Navigation, which itself incorporates two key components. These are the “Fusion” system which enables the combination of the advantages of real-time ultrasound imaging with the high spatial and contrast resolution of CT, MR or PET. The second technological advance is a “GPS-like” system to track and mark a patient’s anatomy during the ultrasound exam, bringing confi-dence and productivity to both diagnostic and interventional studies.In this way, the new system helps to address one of the biggest challenges in ultrasound radiology and vascular care, namely how to leverage clinical images from previous diag-nostic imaging studies for interventional or diagnostic ultrasound procedures. The devel-opment of this new ultrasound architecture, which gives clinicians the advantages of sev-eral imaging modalities involved close collab-oration between GE Healthcare and a global team of radiologists and sonographers.

Ge HealtHCaresolingen, Germany www.ihe-online.com & search 45194

– Issue N°1 – Feb/March 200921MEDiCAL iMAgiNg PRoDUCT NEWS

in the breast. The accessory uses a stereotactic frame fixed between the scanner’s paddles to guide the inser-tion of a compati-ble interventional device into the

breast. Accurate targeting is possible due to the high-resolution 3-D tomographic images acquired. Localisation of the abnormality is verified using a PET-visible line source that is inserted into the needle track allowing the user to confirm trajectory and position. The accessory is compatible with most breast biopsy systems.

NaVisCaN, iNC.San Diego, ca, uSa www.ihe-online.com & search 45198

Digital radiography imaging technologyThe i4 DR system was designed to provide the highest level of image quality while reducing the amount of radiation that patients and medi-cal staff receive during X-ray procedures. The technology behind this superior image quality is the recently developed InfiVision Automatic Image Enhancement software. InfiVision’s one-click image processing allows for the best

possible image quality on the first shot. It uti-lises advanced image processing algorithms and automatically applies optimal image shutters. Images can then be fine-tuned using automatic processing settings optimised for bone, soft tissue and organs.In addition, the i4 DR features a highly customis-able clinical workflow with Graphical UserInter-face (GUI)-integrated generator controls that allow for optimised X-ray and image processing parameters. Eliminating the generator console and thus creating a cleaner, more efficient work-space, i4 DR was also designed with the OEM business model in mind in that it can interface with a variety of flat panel detectors, and is flexible, adaptable, upgradeable and configurable for use

with next generation flat panel detectors for faster speed to market. This, in addition to the company’s global onsite service sup-port, 24-hour customer service and 36-month standard digital system warranty, enables i4 DR to lower the total cost of ownership compared to similar systems.

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Protective coverlets for mammography

Designed to remove the chill from the bucky/receptor plate, Bella Blankets protective coverlets help patients feel more at ease during a mammo-gram. Patient satisfaction levels are improved and complaints that the bucky/ receptor plate is cold are minimised. Made of a fabric-like material, the coverlets also help with positioning by immobi-lising small breasts or those prone to perspiration. Covering both the top and front of the bucky, the coverlets are intended for single use, providing added protection for each patient. Patients with thin skin, cuts in the inframammary fold or those who require a second image after undergoing needle localisation will especially benefit from the coverlets. Available in two sizes, artifact-free and easily disposable, the coverlets are compatible with both digital and analogue units.

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Cranio-caudal CTLM ® view of the right breast. Standard MIP reconstruction show a normal vessel (yellow arrows), tubular in shape and in normal anatomical location. The red arrows outline a large area of neo-vascularity, sphered in shape (non-anatomical), and extending across the breast to involve the skin.

– Issue N°1 – Feb/March 2009 22 MEDiCAL iMAgiNg PRoDUCT NEWS

Rapid, low dose CT scannerA new dual-source CT featuring two X-ray tubes that simultaneously revolve around the patient’s body, the SOMATOM Definition Flash CT scanner requires only a fraction of the radia-tion dose that systems pre-viously required and can rapidly scan even the tini-est anatomical details. For instance, a spiral heart scan

can be performed with less than 1 millisievert (mSv), whereas the average effective dose required for this purpose usually ranges from 8 mSv to 40 mSv. With the fastest scanning speed in CT (i.e. 43 cm/s) and a temporal resolution of 75 ms, complete scans of the entire chest region, for example, can be carried out in just 0.6 seconds. Thus patients are no longer required to hold their breath during the exam as was necessary in the past. The gantry (i.e. the X-ray detector system surrounding the bore) rotates about its own axis in just 0.28 s. It is this rotational speed that enables the rapid

scan speed; the patient is moved through the CT tube more than twice as fast as with any conventional system.

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Oncology-specific image management and storage solutionProviding oncology profes-sionals with a reliable, scal-able way of archiving and accessing the images and data that impact decisions about a patient’s course of treatment, OncoView is designed specifically to archive information cover-

ing the entire cancer treatment process from diagnosis to survivorship and follow-up. Clinicians are using more images to make decisions and to monitor progress over the course of cancer treatments. For image-guided radiotherapy, new images are generated at every step in the treatment proc-ess, resulting in a vast number of images and related information that must be stored, and so clinicians need a reliable system for easily archiving and instantly accessing this information in a meaningful way. The Oncoview image management system supports archiving of the most commonly used imaging modalities in oncology care, including CT, MR, PET, kV X-rays, cone-beam CT and electronic portal images. The system also stores non-imaging data, including radiotherapy treatment plans, dose levels and other important treatment details. The system is designed to supplement a hospital’s existing picture archiving and communication system (PACS) by making it ‘oncology capable,’ or to operate as a stand-alone solution for

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FRoNT CoVER PRoDUCTCompact yet powerful ultrasound system

Designed using the most up-to-date technology, the new Ima-gyne US scanner from the French company ECM offers exceptional image quality and a performance equivalent to that of high-level ultrasound scanners. The instru-ment is small and very easy to use. With its large range of wide band probes, the system is suitable for all clinical applications including gynaecology, obstetrics, abdomi-nal, vascular, breast, prostate, etc., and provides reliable and rapid diagnoses. The wide range of probes (convex, micro convex,

endo-cavity, linear and phased array) uses advanced piezoelectric com-posite technology and provides unequalled bandwidth performance. This enables the full benefits of variable frequency technology to be delivered, thus providing optimal detail of the tissues being examined. Of particular importance in gynaecology/obstetric applications, a 4D option has just been released for the Imagyne scanner. eCmangoulême, france www.ihe-online.com & search 45174

– Issue N°1 – Feb/March 200923MEDiCAL iMAgiNg PRoDUCT NEWS

centres that don’t have such a system. Important information can be stored within a specific archive or within hospital PACS through industry standard communication protocols such as HL7 and DICOM, supporting the trend in medicine toward paperless and filmless clinical operations that speed workflow and improve cost efficiencies. OncoView interfaces seamlessly with any standards-based clinical information management system.

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Hand-carried diagnostic ultrasound systemsAn addition to the ProSound fam-ily of diagnostic ultrasound systems, the ProSound C3 series of hand-car-ried diagnostic ultrasound systems is available. Diagnostic ultrasound is extensively used for a wide range of medical imaging applications including cardiovascular exams, general abdominal exams, obstet-rics, surgery and orthopedics. Hand-

carried diagnostic ultrasound systems are increasingly used at the point of care due to their greater convenience. The series is available in two models. The Pro-Sound C3 accepts a wide range of probes to meet a broad spectrum of exam types, while the ProSound C3cv is designed for examination of the cardiac and circulatory systems. A number of functions are provided to meet the needs of a wide range of exams and new emerging applications. The miniaturised high-performance LSI designed specifically for ultrasound beam forming helps to simultaneously deliver both high image quality and equipment portability. Its low power consumption allows the system to run on batteries for longer. The user can enjoy the full benefits of this hand-carried system in any clinical setting ranging from bedside examination to home visits by doctors.The standard features of the system that enhance examination efficiency include Tissue Harmonic Echo, Spatial Compound Imaging and Adaptive Image Processing (AIP). Spatial Compound Imaging reduces artifacts that are dependent on beam direction to make the images easier to interpret by super-imposing images created through steering the ultrasound beam in multiple directions. AIP also enhances the efficiency of examination by reducing speckle noise and clearly displaying differences in tissues. The user can select the most suitable probe from a wide range including phased array sector, convex sector, linear and endo-cavity probes according to the application. The series also fea-tures a short-cut function from a backlit full keyboard and a slide-out opera-tion panel exclusively designed for ultrasound imaging to enable direct access to the desired imaging mode and system functions, reducing examination time. Operation is intuitive thanks to the Windows operating system.

alOka CO., ltd. tokyo, Japan www.ihe-online.com & search 45175

Digital radiography systemFeaturing the company’s fixed flat panel digital detector, and deliver-ing one of the industry’s highest detective quantum efficiency (DQE) of 77 percent, the Discovery XR650 provides outstanding image clar-ity at low doses. New to the system is a portable detector, offering fur-ther flexibility in the comprehensive radiographic room compared to

previous generations of instruments. The system features several innovative, advanced clinical applications. Dual Energy Subtraction eliminates overly-ing bone obstruction from chest or abdominal images, providing a standard PA radiograph, a soft-tissue only image with the bones removed, and an image of the bones highlighting foreign objects and calcified abnormalities. VolumeRAD allows multiple high-resolution slice images of the human anatomy, including the chest, abdomen, extremities and spine, using an X-ray system. VolumeRAD is performed by a single sweep of the overhead tube assembly across the patient. During the sweep, multiple, low dose expo-sures are acquired. The acquired data are then reconstructed (similar to CT exams) and displayed as a set of images (parallel to the detector plane). Sev-eral automated features that are geared to improving workflow and patient experience are also offered. Auto-image paste, auto-positioning, protocol assist, auto-processing and Repeat/Reject Analysis functions help reduce exam times as well as wait time for processed images. Additionally, the flex-ibility of a portable detector has been added to enable customers to choose a configuration that best fulfills their clinical and workflow requirements.

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Clinical needEach year there are approximately one mil-lion primary hip and knee replacements car-ried out in Europe, with the number growing at over 4% annually. North America, the Mid-dle East and Pacific Rim also have a signifi-cant and growing number of replacements. With an ageing world population, it is likely that the demand for hip and knee replace-ments will continue to grow while the funds to resource them become more scarce. With this in mind, Activ4Life Healthcare Technologies Ltd, initiated discussions with clinicians to determine where there were areas for improvement. What they found was that the two key reasons for carrying out hip and knee replacements were to increase patients’ mobility and reduce their pain, both param-eters that are not currently economically measurable over time. In addition to being a key reason for joint replacement, activity is a vital part of the recovery and rehabilita-tion process, but again, this is currently not effectively measured in patients.

As the ability to walk is a frequent discharge criterion, it is important to ensure that this is maintained in the period early after discharge when hospital staff are no longer available to provide support. It is important to ensure that patients continue to increase activity over several weeks to re-establish mobility. If patients do not show a clearly increas-ing trend in activity levels post-operatively there may be additional complications which warrant attention. Without sufficient exer-cise muscles will weaken leading to a poor outcome and the real possibly of a negative effect on the stability of an operated joint. However, over- exercising a joint early post-operatively can also be a significant risk to

recovery, potentially damaging the integrity of the joint, in which case the life of the joint will be compromised, and a revision will probably be required.

Compliance with the prescribed exercise regime is important for patient outcomes and for reducing the costs associated with poor outcomes and/or revisions. Currently the only method of measuring compliance is by asking patients how much exercise they are taking. This is time consuming and unreliable, as it is subjective and reliant on the patient’s memory. Furthermore, patients who are not complying for whatever reason are unlikely to be detected until the damage is irreversible.

At present, clinicians have to make treat-ment decisions using minimal information

based on ’snapshots’ of subjective measures of activity and pain provided by the patient from time to time, often at intervals of many weeks. What is considered very active by one patient may be considered inactive by another. Established scoring systems such as the Oxford Knee Score, Harris Hip Score and SF-12 are widely used and have some merit but they cannot provide quantitative trends that would show the rate at which a patient is declining pre-operatively, or if recovery is on track post-operatively. Moreover, there are very few published data on the activity char-acteristics of patients according to their dif-ferent physical characteristics. For instance, what does the decline in mobility of a regu-lar tennis player look like compared to the decline of someone who leads a more sed-entary life, but is still in pain and frustrated by declining mobility? Obviously, there will be a broad spectrum of activity profiles for different patients. These need to be known and presented as a baseline for comparison as recovery progresses. Absolute measures of activity alone would be a step forward, but would not yield the ‘whole picture’ or maximum benefits. Clearly, more is needed.

If data on patients’ activity and pain levels were made visible to clinicians, and refer-enced to norms, treatment decisions would be better informed. This would improve many stages of overall patient care including triage of those presenting with joint pain; deter-mination of optimal time for intervention;

OrthOpaedics

the number of hip and knee replacements required is increasing due to ageing populations, and as governments seek to meet demand and contain costs, there is a need to take a fresh look at how costs can be reduced whilst improving patient care. currently clinicians make treatment decisions on hip and knee replacement patients based on their physical activity and pain levels but without having good visibility of those two indicators of patient well-being. if clinicians are given remote and time aggregated access to that information along with clinical analysis of it, decisions all along the care pathway can be better informed with the result that patient outcomes are improved and cost savings are realised.

by d. heaton, dr i. revie and dr M. slomczykowski

Monitoring pain and activity in hip and knee replacement patients

Figure 1. Schematic diagram of the patient activity monitoring system.



www.ihe-online.com/comment/Patient_activity_monitoring

recovery prediction, appropriate exercise regime planning, exercise compliance moni-toring, hospital planning and early detection of complications. Enhanced well as improved efficiency and cost savings.

The ProV3.8 monitoring systemRecognising these needs, the ProV3.8 system was developed to deliver effective reporting of patient activity and pain. Designed to be used on each patient for several months pre- and post-operatively, the system comprises three separate components:

• Patient hardware: a very user-friendly activ-ity monitor and associated dock with a pain reporting facility

• Analysis against clinical “personas”: a compar-ison against a specific activity profile matched to the user

• Reporting: regular reports to the user and clinicians responsible for that user’s care

Patient hardwareAt the start of each day the patient fixes the activity monitor to the waist, under clothing, using a double-sided medical grade adhesive patch. The activity monitor, about the size of a wrist watch and weighing only 15g, is unob-trusive and discreet. A 3-axis accelerometer and onboard processor are utilised to count steps and record each one against time. At the end of the day the patient removes the activ-ity monitor and inserts it into the dock. This incorporates an integral mobile phone mod-ule that transmits the data to a secure server. At this point the patient is given the opportu-nity to record pain level for the day on a scale of 1 - 10 simply by pushing one of two but-tons. There is no requirement for the patient to have an internet connection or any other equipment such as PC, PDA or mobile phone. The patient does not have to be familiar with modern communication technology demands on the user. All that is required is to wear the activity monitor during the day and place it in the dock overnight. Pain recording involves only the push of a single button.

Analysis against personas Each patient’s data is compared against an assigned “persona”: a researched activity norm based on BMI, age, gender, operative state and lifestyle. This persona thus fits the patient’s char-acteristics, and is displayed with the patient’s activity data in the weekly reports. This persona profile is also used in setting patient activity targets, both pre- and post-operatively.

ReportingReports are generated from the analysis and show activity performance and trend lines against expected activity. These reports are delivered both to the decision-making

clinicians and to the patient. Additionally, should activity levels fall outside predeter-mined boundaries, alerts can be generated to the clinician. Such alerts would allow an instruction to the patient to change their exer-cise behaviour appropriately. In the case of under-exercise this would improve outcomes; in the case of over-exercise a revision could be avoided in some patients.

Improved outcomes and cost savingsHow the reports feed into the decision-mak-ing process along the care pathway can be illustrated by considering the different phases of the patient’s care in Figure 2. The green line shows a typical long-term activity profile for a patient having a primary hip replacement. • Throughout the period of care, remote mon-

itoring and visibility of the patient’s well-being can reduce the number of visits to cli-nicians: primary care doctors, surgeons and physiotherapists.

• It is well documented that delaying interven-tion for too long can result in a sub-optimal recovery; the patient takes longer to recover and the eventual plateau of activity level reached is lower than for earlier interven-tions. The red line illustrates the benefits of operating at the optimal time; a sustained higher level of activity more quickly. Con-versely, an intervention before the optimal time is inefficient as it increases the likeli-hood of a revision later in life. In addition, the benefits, as perceived by the patient, are less. Enabling an informed decision on when to operate will, in some cases, allow the use of conservative, lower cost treatment options in the short term, thus allowing those with a more urgent need to be referred to secondary care earlier.

• Limited healthcare resources means that patients’ activity cannot be monitored as

closely as would be ideal and thus discharge planning is often conservative. The instant availability of activity trends during the hos-pital post-operation period, together with increased patient confidence from knowing monitoring will continue at home, allows an earlier discharge from hospital with associated cost benefits.

• If activity levels are much lower than expected, or pain levels consistently higher, alerts that there may be a complication are generated to the clinicians. Such alerts also notify patients and their surgeons of inappropriate post-operative activity such as excessive or too demanding or too early exercise.

• Once patients are discharged from hospi-tal and are back at home, monitoring and reporting results in increased se|f-awareness, encouraging self-management of care. In the longer term studies have shown that people who are able to quantify their activity lev-els tend to take more exercise, the obvious resulting health benefits.

SummaryThe implementation of this system allows bet-ter clinical decision-making for hip and knee replacement patients, leading to improved outcomes and cost savings from:

• Triage of patients presenting with joint pain• A reduction in incorrect referrals from

primary to secondary care• A reduction in unnecessary procedures• Quicker discharge from hospital• Fewer post-operative visits to clinicians• Quicker recovery post-operatively• Informed patient self management• Recovery to a higher level of activity• Early detection of complications allowing

more conservative treatment options and less remedial work.

• Compliance with common government poli-cies of patient self-management, improved quality at lower cost, measurement of quality, better use of ICT and data management.

The authorsDavid Heaton BSc, Sales and Marketing Director, Dr Ian Revie PhD, CEO, Activ4Life Healthcare Technologies Ltd.Dr Mike Slomczykowski MD PhD, Medical Director, Healthcare Technologies Ltd.www.A4LHEALTH.com

[email protected]


Figure 1. The variation with time of activity levels at different phases during patient care. The green line shows the typical long-term activity profile for a patient having a primary hip replacement. This

is characterised by a steady, then steep, decline in activity prior to the operation followed by a rapid, then slower, increase in activity after the operation. The red line shows the benefit of carrying out the operation at the optimal time, i.e. not too late and before the loss in activity is dramatic. Post-opera-

tively, a sustained higher level of activity is attained more quickly.


St Trudo Regional Hospital, Sint Truiden, Belgium Located in the Flemish-speaking part of Bel-gium in the town of Sint Truiden, the St. Trudo Regional Hospital is a 310-bed hospital that serves the Limburg and Vlaams-Brabant regions of the country. Its 700 employees and 80 doctors care for more than 11,000 patients admitted to the hospital annually. The hospi-tal recently installed a wireless network and uses this infrastructure to support Wi-Fi-based active radio-frequency identification (RFID) tags, in particular to track and manage expensive specialty mattresses, IV pumps and wheelchairs that are required throughout the facility. St. Trudo also uses the wireless network to accurately monitor the temperature inside the hospital’s data centre.

The specialty mattresses, known as anti-decu-bitus mattresses, help prevent pressure sores in patients who must remain in the hospital for extended periods. The hospital’s mattresses, as well as the IV pumps and wheelchairs are in con-stant use and continual movement throughout the facility. Before installing the new asset track-ing solution, staff often had to manually search the entire facility to locate needed equipment, which wasted a substantial amount of time and reduced overall utilisation of the patient care equipment. Moreover, when the required equip-ment wasn’t readily available, the hospital often had to rent others, incurring significant expenses and delays.

To solve this problem, St. Trudo implemented Wi-Fi-based RFID tags and AeroScout’s Mobi-leView software. The tags are attached to the specialty mattresses, IV pumps and wheelchairs, enabling accurate, real-time visibility and man-agement of those assets. The system is also set up to alert hospital personnel when the number of wheelchairs available for use reaches a critically low level, or whenever a wheelchair is inactive for two hours so that it can be returned to the reception area.

In addition, Wi-Fi-based temperature-monitor-ing application is installed in St. Trudo’s server room (see technology primer opposite). The application also uses the wireless infrastructure to transport information — in this case, temper-ature readings — to the network. This enables

the hospital’s IT department to remotely moni-tor the temperature of the room from anywhere in the hospital, or even to transmit alerts to the home of the appropriate facilities engineer.

“The new system has made a significant improve-ment in the way we operate,” said Daniel Loos, manager, information technology, at St. Trudo. “The staff are more satisfied and much more efficient with their time. With the new system, we have been able to increase the utilisation of expensive mattresses, IV pumps and wheel-chairs, as well as reduce expenses related to rent-ing extra equipment. Best of all, we can improve service and care for patients who require the use of the tracked equipment.”

Jan Yperman Hospital,Ypres, Belgium Housed in a brand new building inaugurated in 2007 and featuring state-of-the-art telecom-munications systems, the Jan Yperman hos-pital in Ypres, Belgium, has about 550 beds, 1,000 employees and 100 doctors. Each year, the hospital accepts 15,000 patient admissions and 18,000 one-day hospitalisations. The hos-pital has opted for for a “Wi-Fi–Based Active RFID solution”, based on a Telindus LAN and WiFi system for tracking patients and medical equipment in real time.

Approximately 1,000 pieces of equipment (infusion pumps, wheelchairs, beds, patient monitors, etc.) were fitted with Aeroscout Active RFID tags, not only saving medical staff precious time in locating these assets, but also making it easier for managers to main-tain them, establish an inventory and reduce the risk of theft.

Temperature-monitoring tags are used for refrigerators containing lab specimens, blood bags and other temperature-sensitive items. Such continuous monitoring ensures safe operation and correct temperatures. Approximately 400 tags with call buttons ensure better protection for medical staff, who are sometimes confronted with aggres-sive patients. The tags are also a useful tool for keeping track of disoriented patients such as those suffering from Alzheimer’s disease.

hOspital ManageMent

The fitting of RFID tags to movable equipment, such as weelchairs, means that the location of the asset can be determined directly using Wi-Fi networks.

From the organisational and management point of view, a modern hospital is an extremely complex system. efficient running of a hospital can therefore be a daunt-ing task but is nevertheless called for more and more since increased efficiency in the management of hospital facilities can not only result in significant savings but also in improvement in patient outcomes.One of the most difficult aspects of modern hospital management is keeping track of the many portable and movable pieces of equipment, whose physical location in the hospital can vary enormously, depending on the use the patient is making of the equipment.

items such as iV pumps, specialised mattresses or even apparently mundane pieces of equipment such as wheelchairs can at any one time be located almost anywhere in the hospital. Frequently, hospitals are required to compensate for their ignorance of the precise whereabouts of their own property by purchasing more items than would otherwise be necessary. the use of modern radio Frequency identification (rFid) systems is a cost-effective method of managing such movable but important equipment. here we look at how two Belgian hospitals have implemented their rFid systems.

rFid tags make hospital equipment management easier


www.ihe-online.com/comment/RFID


the technology behind asset locations systems

The configuration at St. Trudo’s hos-pital is based on three components:

1) A Wireless Network. This was based on Cisco’s Unified Wireless Network system (www.cisco.com). This is designed to deliver optimal wireless LAN secu-rity, innovation, and investment protection and supports real-time business-critical applications. The Network creates a secure, mobile, interactive workplace for organi-sations deploying WLANs and delivers greater reliability and higher throughput based on the IEEE standard (802.11n) for the implementation of WLAN com-puter communication in the 2.4, 3.6 and 5 GHz spectrum bands. In the Jan Yperman hospital, the network is a Telindus system, www.telindus.com.

2) Visibility system. This was Aeroscout‘s Unified Asset Visibility system (www.aeroscout.com) which has already been installed in over 100 hospitals around the world. Aeroscout is the only Wi-Fi Visibility solutions provider endorsed by the Ameri-can Hospital Association (AHA). The Unified Asset Visibility sys-tem is a platform that is able to provide enterprise visibility over a single infrastructure, combining multiple types of visibility includ-ing Real Time Location Systems (RTLS), Active RFID, Passive RFID, sensors and telemetry. This means that a user can moni-tor all of the valuable data about their mobile assets from a single interface in real-time, and apply a consistent set of context-based rules, no matter what the source of those data might be. There are several possible configurations of the Visibility system in addition to the RTLS used in St Trudo, which wirelessly determines the precise location of tags.For example, in situations where the presence or, sometimes more importantly the lack, of an asset is deemed to be critical, the system can be con-figured based on the use a single Access Point or receiver to detect these crtical tags.

In the so-called Chokepoint detection configuration, the passage of a tag through a defined area such as a gate or doorway, can be used to trigger “events” such as alarms, tag behav-iour modification, or data retrieval. In addition to simply locating assets, configurations exist for the han-dling of valuable status information such as Telemetry and Sensor data. For example, tags with a built-in

temperature sensor can communi-cate environmental temperature (as used in St Trudo), or a tag can be con-nected to equipment/vehicles to com-municate maintenance status, fuel level and other critical information.

3) Active RFID tags. These were also supplied by Aeroscout (www.aeroscout.com), the develop-ers of the original active RFID tag. An active tag is distinguished from a passive tag in that it is equipped with a

battery that can be used as a partial or complete source of power for the tag’s circuitry and aerial. Some active tags contain replaceable batteries capable of years of use; others are sealed units. It is also possible to connect the tag to an external power source. The major advantages of an active RFID tag are that it can be read at distances of thirty metres or more, greatly improving the utility of the device; in addition it can have other sensors built into it that use its electrical source for power.


28 neWs in BrieF – Issue N°1 – Feb/March 2009

New guidelines for use of breast MRI to supplement standard imaging

Updated guidelines for physicians that rep-resent best practices for using MRI to newly diagnose breast cancer and to make treatment decisions have been published in the Journal of the National Comprehensive Cancer Net-work (NCCN), a non-profit alliance of 21 of the USA’s leading cancer centres. Breast radiologists and surgeons at the Seattle Cancer Care Alli-ance (SCCA) and the Roswell Park Cancer Insti-tute in Buffalo, NY, authored the paper upon which the guidelines are based. Among the key recommendations are the following: • MRI is not a substitute for screening or diag-

nostic mammography and, when indicated, diagnostic breast ultrasound. MRI supple-ments the use of these standard imaging tools in appropriately selected clinical situations.

• For women with diagnosed breast cancer, MRI provides enhanced detection in both the breast known to have cancer and the opposite, or “contralateral,” breast.

• Surgical decisions should not be based solely on MRI findings because not all suspicious lesions on MRI are cancer. Suspicious lesions should be biopsied before a surgery plan is devised in order to avoid surgical overtreatment.

• In the rare instances where cancer is found in the lymph nodes but not the breast, an MRI can find the location of cancer in the breast in nearly 60 percent of women.

Breast MRI is a relatively new clinical tool for detecting breast cancer and techniques for using the sensitive equipment vary by site. Many clinicans have urged that clear standards for technical parameters be established, as well as performance measures at clinical sites that offer MRI. The MRI guidelines adopted by the NCCN state that MRI examinations should be performed and interpreted by an expert breast-imaging team working in concert with a multi-disciplinary diagnosis and treatment team. Breast MRI exams require dedicated equip-ment and breast-imaging radiologists who are familiar with the technical details for image interpretation. The NCCN guidelines also say that imaging centres need to have the ability to perform MRI-guided needle biopsy sampling of lesions detected by MRI to properly evaluate possible abnormalities. http://www.ingentaconnect.com/content/jandb/jnccn/2009

Radioimmunotherapy: promising treatment for HIV infection

Scientists at Albert Einstein College of Medicine of Yeshiva University, USA, have used radio-immunotherapy (RIT) to deliver doses of radiation that selectively tar-get and destroy microbial and HIV-infected cells. The

experimental treatment holds promise for treat-ing various infectious diseases, including HIV and cancers caused by viruses. The research was presented at the annual meeting of the Ameri-can Association for the Advancement of Science (AAAS), the world’s largest general scientific society and the publishers of the journal Science.

By attaching radioactive material to a particular antibody, radiation can be targeted at specific cells that express the corresponding antigen, minimising damage to other tissues. This level of specificity is not possible with existing forms of radiation therapy.RIT was originally developed as a therapy for cancer treatment and has been the most suc-cessful therapy used so far in treatment of non-Hodgkin lymphoma, the cancer that originates in cells of the immune system. Since viruses are quite different from cancer cells, devising radioimmunotherapy for HIV poses significant challenges. Viruses easily avoid radiation directed at them and can readily repair any damage that might occur. In addi-tion, HIV is present in immune cells keeping the virus beyond the reach of antibodies. The RIT devised by the Einstein researchers con-sists of an antibody for glycoprotein 41 (gp41) and a radioactive isotope, namely Bismuth-213, bound together by a ligand. The gp41 antibody was selected because the corresponding gp41 antigen is reliably expressed on the surface of cells infected with HIV. In addition, unlike other HIV-related glycoproteins, gp41 antigen usually is not shed into the bloodstream, which would lead many of the radioactive-labelled antibod-ies to miss their target. Bismuth-213 was chosen because of several characteristics, including a half-life of only 46 minutes. Such a short half-life allows just enough time for the treatment to be administered and for the radioactive anti-bodies to exert their effect. After four hours, Bismuth-213 falls to negligible levels. The treat-ment has been shown to effectively eliminate HIV-infected human cells in both laboratory and animal studies, the latter involving two dif-ferent models of mice with HIV. The team is now conducting pre-clinical testing of the therapy’s efficacy and safety in preparation for a Phase I clinical trial in HIV-infected patients.http://www.aecom.yu.edu/home/news.asp?id=301


– Issue N°1 – Feb/March 200929neWs in BrieF

MRI shows brain atrophy pattern that is predictive of Alzheimer’s

Using special MRI meth-ods, researchers have identified a pattern of regional brain atrophy in patients with mild cogni-tive impairment (MCI) that indicates a greater likelihood of progression to Alzheimer’s disease. The findings are pub-lished in the online edi-tion of Radiology. The

study’s lead author, Linda K. McEvoy, Ph.D., assistant project scientist in the Department of Radiology at the University of California San Diego School of Medicine in La Jolla, USA said that previously this pattern had been observed only after a diagnosis of probable Alzheimer’s disease. The current results show that some individuals with MCI have the atrophy pattern characteristic of mild Alzheimer’s disease, and these people are at higher risk of experiencing a faster rate of brain degeneration and a faster decline to dementia than individuals with MCI who do not show that atrophy pattern.For the study, Dr McEvoy and colleagues set out to determine if they could identify a pattern of regional atrophy characteristic of mild Alzheimer’s disease in order to aid in the prediction of cognitive decline in patients with MCI. The researchers analysed brain MR images from 84 patients with mild Alzheimer’s disease, 175 patients with MCI and 139 healthy controls, using semi-automated, individually specific quantitative MRI methods. The results showed widespread cortical atrophy in some patients with MCI, involving all cortical areas except those involved with process-ing of primary motor and sensory information. However, most indicative of future cognitive decline were atrophy in parts of the medial and lat-eral temporal lobes and in the frontal lobes. This pattern was also present in the patients with mild Alzheimer’s disease. Although these individuals were reporting problems mainly with memory, the atrophy involved more than just memory areas, extending into brain regions involved in plan-ning, organisation, problem solving and language. Follow-up data were available for 160 patients with MCI. The patients exhibiting atrophy in the brain regions described above showed significant one-year clinical decline and structural brain loss and were more likely to progress to a probable diagnosis of Alzheimer’s disease. MCI patients without that pattern of atrophy remained stable after a year. Dr McEvoy hopes that these findings will have an impact on the design of clinical trials to test medications that may slow or halt the progression of Alzheimer’s disease. http://radiology.rsnajnls.org/cgi/content/full/ 2511080924

Optical brain imaging decodes preference Researchers at Canada’s largest children’s reha-bilitation hospital, namely Bloorview Kids Rehab, have developed a technique that uses infrared light brain imaging to decode prefer-ence, with the goal of ultimately opening the world of choice to children who can’t speak or move. In a study published this month in The Journal of Neural Engineering, Bloorview sci-entists demonstrate the ability to decode a per-son’s preference for one of two drinks with 80 per cent accuracy by measuring the intensity of near-infrared light absorbed in brain tissue.

Most brain-computer interfaces designed to read thoughts require train-ing. For example, in order to indicate yes to a question, the subjects need to do an unrelated mental task, such as singing a song in their head. The nine

adults in the study received no training. Prior to the study they rated eight drinks on a scale of one to five. Wearing a headband fitted with fibre-optics that emit light into the pre-frontal cortex of the brain, they were shown two drinks on a computer monitor, one after the other, and asked to make a mental decision about which they liked more. When the brain is active, the oxygen in the blood increases and, depending on the concentration, it absorbs more or less light. In some people the brain is more active when they don’t like something, and in some people it’s more active when they do like something. After allowing the computer to recognise the unique pattern of brain activity associated with preference for each subject in the study, the researchers accurately predicted which drink the participants liked best 80 per cent of the time. In future, a portable, near-infrared sensor that rests on the forehead and relies on wireless technology could be developed, opening up the world of choice to children who can’t speak or move. http://www.iop.org/EJ/abstract/1741-2552/6/1/016003 Multivitamins have no impact on risk of cancer or heart disease in postmenopausal womenThe largest study of its kind concludes that long-term multivitamin use has no impact on the risk of common cancers, cardiovascular dis-ease or overall mortality in postmenopausal women. The results of the Women’s Health Initiative study, led by researchers at Fred Hutchin-son Cancer Research Center, were published in the February issue of the Archives of Internal Medicine. The study focused on the effects of multivitamins because they are the most commonly used supplement. It assessed multivitamin use among nearly 162,000 women enrolled in the Women’s Health Initiative, one of the largest U.S. prevention studies of its kind and designed to address the most common causes of death, disability and impaired quality of life in postmenopausal women. The women were followed for about eight years. Nearly half of the study participants reported using multivitamins on a regular basis. Multivitamin users were more likely to be white, live in the western United States, have a lower body-mass index, be more physically active and have a college or higher degree as compared to non-users. Multi-vitamin users also were more likely to drink alcohol and less likely to smoke than non-users, and they reported eating more fruits and veg-etables and consuming less fat than non-users. During the eight-year study period, 9,619 cases of breast, colorectal, endometrial, renal, blad-der, stomach, lung or ovarian cancer were reported, as well as 8,751 cardiovascular events and 9,865 deaths. The study found no signifi-cant differences in either risk of cancer and heart disease or longevity between the multivitamin users and non-users. http://archinte.ama-assn.org/cgi/content/full/169/3/294

M E D I C A LE Q U I P M E N TS O L U T I O N S

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IHE - RESCUE LIFE 2008 22-01-2009 16:38 Pagina 1


prOdUct neWs – Issue N°1 – Feb/March 2009 30

Carbon monoxide monitors to detect tobacco smokingMeasuring alveolar carbon monoxide concentration in ppm, as well as percentage carboxy-haemoglobin, the Micro CO operates from a single 9V PP3 battery, which allows 8000 tests to be carried out. Measure-ments are easily obtained from a single expiration, facilitated by an auto-zero function when the moni-tor is turned on, combined with a breath hold count-down timer. Results are displayed instantly on the large LCD display, and additional green, yellow and red lights indicate heaviness of smoking.

Cardinal HealtH GmbHHoechberg, Germany www.ihe-online.com & search 45210

New range of nebulisersBased on aerosol generation technology, in which the medication is nebulised into an ultra-fine mist able to penetrate deep into patients’ bronchial tubes or pulmonary alveoli, a new range of nebulisers is available. Particles smaller than

6 micrometers diameter, necessary for the treatment of pulmonary alveoli, can be generated. The model IH 50 features a nebulisation method that uses an ultra mod-ern oscillating membrane, which is partially porous, to nebulise the inhalant with a capacity of >0,3mL/min. Requiring only a short inhalation time, the IH 50 is suitable for treating children with respiratory diseases. Its compact design and battery operation make it ideal when travelling. The inhaler is supplied with a storage box, mouthpiece and masks for adults and children.

Models IH 25 and IH 20 are designed to treat the upper and lower respiratory tract in case of colds, asthma or similar disorders. Here, the liquid medica-tion is nebulised using compressed air technology with a capacity of > 0.21 mL/min (IH 25) and > 0.18 mL/min (IH 20). Both these devices operate on mains power and feature a compact, light design. They are supplied with mouthpiece, nosepiece, masks, extra-long compressed air tube and filter.

beurer GmbHulm, Germany www.ihe-online.com & search 45203

Data collection and processing Arioform, a new digital form management solution, offers a faster, more accurate and efficient method of collecting and processing the data acquired by mobile personnel. Suitable for healthcare centres, the software eliminates the need for personnel to return to the office to re-enter form data collected in other hospital locations. Instead, forms can be simply completed on-site, using either a digital pad or a digital pen, and the data can be transmitted to the relevant office electronically. Paper copies of the form can be provided for the client or service user. Suitable for any type of form, including patient files, health and safety checklists, surveys, maintenance reports, order forms, inventories and meeting minutes, the software is available in two versions, namely Arioform Enterprise and Arioform Vista. The former version, which is a server-based system, is designed for use by multiple personnel; the lat-ter version is designed for capturing digital data on single pageforms. Form data can include tick boxes, radio buttons, boxed fields and free text fields, which can be stored graphically. Arioform Vista software also incorporates handwriting recognition technology, which enables workers to convert their handwritten forms into digital data on their PC.

Selwyn eleCtroniCS Sevenoaks, Kent, uK www.ihe-online.com & search 45204

Silver antimicrobial technologyRecent comprehensive studies have shown that silver ion technology, applied to both equipment and furniture, reduced levels of bacteria in a healthcare environment by up to 95.8%. Further results showed that products treated with silver harboured 92.6% fewer bacteria on their sur-faces than similar untreated products in the same

environment. The products tested included waste bins, hospital beds, blinds, tiles, door handles and light switches. A number of leading manufacturers of healthcare equipment and furniture now incorporate BioCote silver ions into their products at the manufacturing stage. The silver ion additive gives the prod-ucts built-in antimicrobial protection, and can be incorporated into a variety of materials including plastics, fabrics, paints, powder coatings and papers.

bioCote ltdwolverhampton, west midlands, uK www.ihe-online.com & search 45202

For physicians, nursesand other allied healthcareprofessionals

Abstract submission deadline15 April 2009

For more information, contactEuropean Societyof Intensive Care Medicine(ESICM)Annual Congress secretariatMrs Estelle FlamentAvenue Joseph Wybran, 40B-1070 BrusselsTel +32 2 559 03 55Fax +32 2 527 00 [email protected]

European Society ofIntensive Care Medicine

22nd annual congress

Vienna, Austria11-14 October 2009

ESICM VIENNA 2009

Vien09 IHE 101x178 ad:Vien09 18/01/09 22:59 Page 1


prOdUct neWs – Issue N°1 – Feb/March 200931

Laser system for kidney stone removal Providing flexibility to treat any stone in the bladder, ure-ter or kidney, the Odyssey 30 Holmium Laser System can also be used to treat tumours and urethral strictures. Using patented, variable pulse width technology, the system allows surgeons to minimise stone migration as well as offering the flexibility to switch from disintegration of stones to ablation and coagulation of soft tissue. The system is equipped with enough power to treat any renal stone, regardless of size, position or composition, as well as incorporating a green aiming beam to enhance visibility of the treatment site.

New research has predicted an increase in the proportion of the popula-tion affected by kidney stones due to dehydration and diet. In the UK alone, stones occur in nearly 12 of every 100 men and four of every 100 women at some point in their lives. With the incidence of kidney stones increasing, the need for innovative technology in operating theatres is vital. Although there are many treatments and surgical options available for kidney stones, fragmentation with a laser is very precise. It causes minimal damage, and the results are typically much better at immediately removing the obstruction.

Cook MediCal inCBloomington, in, U.S.a. www.ihe-online.com & search 45192

Removable posterior urethral stentProviding a viable solution for patients recovering from complications of bladder and prostate cancer operations, the Allium Bladder-neck Stent is a removable posterior urethral stent for patients who have developed a steno-sis at the bladder neck after radical removal of the prostate or the bladder because of cancer. The device is a super-elastic structure inserted into the posterior urethra of patients who have undergone radical prostatectomy (for prostate cancer) and radical cystoprostatectomy (for bladder cancer). In up to 18% of these patients a stenosis may develop at the anastomosis site, necessitating repeated dilatations to allow for reasonable voiding of urine. Currently, the conventional management of these stenoses is frequently per-formed by mechanical dilations, endoscopic incisions or laser vaporisation. The success rate of these procedures is low and patients have to undergo repeated treatments. The bladder-neck stent provides a viable option that does not require a highly specialised reconstructive bladder neck repair

procedure. Urologists will be able to perform a simple once-a-year treat-ment under regional anaesthesia that has proven to be more effective than conventional treatments that have to be repeated frequently.

alliUM MediCalCaesarea, israel www.ihe-online.com & search 45191

IR sources for capnography and anaesthesia monitoring instrumentsInfrared sources from Leister Technologies are micro-machined, electrically modulated thermal infrared emitters featuring true black body radiation characteristics, low power consumption, high emissivity and a long lifetime. Based on a resistive heating element integrated onto a thin dielectric mem-brane, which is suspended on a micro-machined silicon structure, the IR sources are ideal for capnography and anaesthesia monitoring instruments.

leiSter ProCeSS teChnologieSkägiswil, Switzerland www.ihe-online.com & search 45190

NOT JUST ANY STERILISER

Millennium 17 and 22 liters> Single-piece stainless-steel

chamber with, brilliant electro-polishing for longer durability and easy cleaning.

> Instant steam generator gives high quality saturated steam and faster cycle times.

> High performance fractionated vacuum pump.

> Stainless steel wire trays for fast drying.

> Robotized door-locking mechanism with triple protection for added safety.

Millennium 5,5 liters> Only 18 minutes

(drying included) to sterilise and dry wrapped hollow (handpieces) and solid loads!

> Only 9 minutes (drying included) to sterilise and dry unwrapped solid instruments in the Emergency cycle!

From the fi rst pre-vacuum table-top steriliser in 1993, to the third generation Millennium product line, you can count on Mocom for innovation, reliability and performance.

Mocom srlwww.mocom.it • [email protected]

ONLY

minutes18

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minutes9


FrOnt cOVer prOdUctPortable spirometer

A small portable spirometer with the latest technological advances, the DAT-OSPIR MICRO is available in three dif-ferent models, two of which are fitted with graphic touch screens (PDA type) that facilitate operation. The instrument allows different configurations for use

both in the clinic and at home. A USB port provides connection to a PC or an external printer, as well as to other devices via Bluetooth con-nectiontechnology; data can be exported to other management systems and a PIN security system is available. Incorporating a large number of parameters related to FVC, VC and MVV, as well as a pulseoximetry (SpO

2) option, the spirometer has a database capable of storing up to

1000 tests; a programme for quality control of tests is included. Acoustic incentives ensure that the instrument is ideal for use with children.

Sibel S.a.barcelona, Spain www.ihe-online.com & search 45115

prOdUct neWs – Issue N°1 – Feb/March 2009 32

Shock-proof aneroid blood pressure meter

Blood pressure meters are very sensitive and bang-ing or dropping them can damage the internal mech-anism leading to false readings. This can of course be

disastrous for patients and their treatment. A ‘two components’ technology has been devel-oped that avoids any potential impact and pro-tects the measuring system against shock. The shock-proof R1 aneroid blood pressure meter, which utilises this technology, is shock-proof up to a falling height of 120 cm. Its unique features include a new patent-pending metal air channel, which results in stable needle deflection in both directions. The high-precision air release valve can now be turned without any resistance. The tube connection at the top of the pressure gauge ensures an unhindered blood pressure measure-ment. A further advantage of this blood pres-sure meter is the possibility of pumping up the device in minimal time due to a new ball design with an integrated spoon. Tests show that regu-lar meters can deviate by up to 10mmHg after shock and vibration damage, whereas this blood pressure meter hardly ever deviates by more than 3mmHg, i.e. well within the accepted limit. The instrument is available in a variety of different sizes and cuff options. In addition, a special set including three different cuff sizes and a storage box is offered.

rudolf rieSter GmbH Jungingen, Germany www.ihe-online.com & search 45182

General purpose test lungProviding a broad spectrum of ben-efits to the respi-ratory care field, the EasyLung is an affordable, versa-tile general pur-pose test lung. It

is ideal for ventilator manufacturers validating the safety of their products, for ventilator train-ing and for biomedical engineers perform-ing general service procedures. The EasyLung combines a specific design with high-quality, replaceable parts. The entire instrument is autoclavable at 134°C. Its unique double-conus multi-connector also ensures a direct connection to all tubing systems.

imtmedical aG buchs, Switzerland www.ihe-online.com & search 45180

Anaesthesia machine for use with MRI scanner

The MRI 508 is the first anaesthesia machine designed for safe, reliable use right tnext to an MRI scanner. Tests in collaboration with leading MRI scanner suppliers show diagnostic images are undisturbed and performance superb in all seven ventilation modes. Operators familiar with the company’s innovative Siesta i range will need no extra training as the user interface and patient system are identical. The space-saving design incorporates even ventilation modes including pressure support ventilation (PSV) and pressure regulated volume target ventilation (PRVT). This is a lung-protective ventilation mode that com-bines the advantages of volume-controlled ven-tilation and PCV, enabling optimum ventilation and oxygen delivery during surgery, which in turn reduces the risk of post-operative complica-tions and promotes faster recovery. An integrated breathing system (IBS) and high-level safety fea-tures are provided. The IBS includes a bag-in-bottle, absorber and patient circuit integrated in one system, which significantly reduces tubing connections between machine and patients. The same bag-in-bottle can be utilised for adults and infants. Unique vertical inspiration/expiration valves with fast response reduce deadspace, and a built-in manual ventilation valve is provided above the manual ventilation bag connection. A large TFT screen displays all relevant values.

dameCa a/Sroedovre, denmark www.ihe-online.com & search 45179

Imaging infrastructure solution

Providing large-scale multimedia storage for all types of medical images and diagnostic results for hospital groups, regional healthcare organisations and national medical archives, the IMPAX Data Center solution consolidates the data from dispa-rate systems into a single point of storage to serve the needs of the enterprise. A highly scalable and fault tolerant DICOM archive system is designed

to store clinical DICOM data objects, including DICOM encapsulated non-imaging objects such as waveforms, structured reports and PDFs. A key benefit of the solution is that care providers are able to easily access various datasources within the hospital or regional enterprise through one mechanism. The solution delivers clear patient management benefits as exams and results will be available at every location in the Hospital Enterprise, consequently enhancing patient care. The system is designed to meet the needs of new technologies such as multi-slice CT and allows for the extension of PACS into other image-intensive clinical departments, including cardiology and orthopaedics. Due to its adherence to open stand-ards, the IMPAX Data Center can be part of any existing or new Agfa HealthCare PACS, or exist in legacy or multi-vendor environments, further increasing data sharing and disaster recovery.

aGfa HealtHCaremortsel, belgium www.ihe-online.com & search 45181

Aerosol disinfection systemOffering efficient infection control, the MobiWatch MaxiBIO dry mist decontamination system ensures that absolutely all surfaces are fully

decontaminated. The system effectively elimi-nates microorganisms when used in conjunc-tion with MicroSol3+ Sporicide, providing an efficient deep cleaning procedure for any labora-tory or clinical environment. The system com-prehensively decontaminates not only accessible areas but also out-of-reach surfaces, and can quickly and effectively treat spaces up to 500m3, with personnel being able to return to the treated area within four hours of decontamination. The pressurised MicroSol3+ Sporicide solution is automatically sprayed within the targeted area via a dry-mist nozzle, which generates <10micron particles, providing 100% saturation of the area and giving a sterile and residue-free environ-ment. The system is operated by a timer, which allows personnel to safely leave the area that is to be disinfected before the procedure begins. This system provides a comprehensive, low cost, deep clean without any labour-intensive procedures, thus freeing up personnel time; the process is completed within a matter of hours minimising overall downtime. The unit’s small footprint and light weight (345mm x 320mm x 320mm, 11 kg) allows it to be easily moved to decontaminate areas where and when required.

anaCHemluton, bedford, uK www.ihe-online.com & search 45183

prOdUct neWs – Issue N°1 – Feb/March 200933

System for delivery of NCPAPContinuous Positive Airway Pressure (CPAP) is a treat-ment modality in which air is slightly pressurised and pro-vided to the patient through-out the breathing cycle. CPAP is necessary for infants with a number of respira-tory conditions, as well as for very low birth weight infants (VLBWIs). It is widely used in neonatology as an alternative to intubation and mechani-cal ventilation. Nasal CPAP (NCPAP) is administered through the nose.The nCPAP 200 is an effec-tive solution for the delivery

of NCPAP to infants. This system provides air through soft nasal prongs. Alternatively, physi-cians may opt for using a mask. The pressure, flow rate and oxygen concentration of the air delivered to the baby can be controlled accu-rately using the instrument. Apnea monitoring can also be carried out using this system. Fea-turing a large, clear display and superior tech-nology, the system has no moving parts. The controls are easy to use and the system is very compact and operates quietly.As always, Phoenix has designed the system with the utmost safety of the infant in mind, and reliable alarms have been provided.

PHoenix mediCal SyStemS Pvt. ltd.tamil nadu, india www.ihe-online.com & search 45170

Compact, economical uroflowmeterEnabling the non-invasive screen-ing for urinary obstruction by measuring urine flow over time, the Microflo II is a compact and eco-nomical uroflow-meter. Uroflow-metry is widely carried out by urologists, urogy-

naecologists, gynaecologists, rehabilitation specialists and general physicians.This uroflowmeter offers exceptional value without sacrificing speed, accuracy or dura-bility. With one button push, the instrument automatically calculates and reports all stand-ard clinical uroflow measurements. It performs the complete test and print-out in less than two minutes. An auto-scaling feature optimises the appearance and readability of the printed record. The instrument can be mounted on the

wall, making it an ideal solution for physicians who wish to conserve space or place the instru-ment in a discreet location. Although it is a very economical device, the system produces uro-flow charts of excellent quality as well as highly accurate flow rate and volume measurements.

life-teCH, inC.Stafford, tx, uSa www.ihe-online.com & search 45171

Online hospital management system and patient records system

A fully integrated online hospital management system, which improves the day to day running of hospitals and the way patient information is stored and accessed, is now available. A revolu-tionary online medical records service, which allows patients to access their own medical records, dating back from the day they were born, is also available. Both systems, namely Medsystem Online (designed for healthcare professionals to run healthcare institutes) and Medrecord Online (the online health record designed for patients) work seamlessly together, offering a valuable online service and a unique way of accessing data. Medsystems Online runs the functions of a hospital, including patient appointments, shift patterns, patient’s results such as blood tests, fully integrated PACS (X-rays, scans ultrasound), bed admissions, referrals to specialists and also telemedicine. The built-in referral system and messaging means that there is no chance of losing data; confidential-ity is carefully respected. Medrecord Online is an online health record system, which stores people’s medical history, allowing individuals to access and control their own health records. Each person carries a Medcard; this is a ‘dumb card’ allocated to a person, which has a unique number on it as well as a bar code on the back. No data are stored on the card so any loss of the card is without consequence. The system is cheap to replace, easy to use and offers 100% data protection and security. All users have to do is log-in and access the information for which they are looking. Both systems use the latest cutting edge technology.

meddServe limitedbrentwood, essex, uK www.ihe-online.com & search 45172

HAVE YOU RENEWED YOUR FREE SUBSCRIPTION ?www.ihe-online.com



– Issue N°1 – Feb/March 2009 34 shOW preVieW

SymposiaRefresher CoursesWorkshopsIndustrial Symposia & ExhibitionAbstract Presentations

CME AccreditationEACCME - UEMS

Deadline abstracts:December 15th 2008Online submission:

www.euroanesthesia.org

ESA SecretariatPhone +32 (0)2 743 32 90

Fax +32 (0)2 743 32 98E-mail: [email protected]

2009EuroanaesthesiaMilan, Italy

June 6-9The European Anaesthesiology Congress


calendar OF eVentsMarch 24-27, 2009ISICEM - 29th International

Symposium on Intensive Care and

Emergency Medicine

Brussels, BelgiumTel. +32 2 55 3631Fax +32 2 555 4555e-mail: [email protected]

April 1-3, 200913th SE Asian Healthcare &

Pharma Show 2009

Kuala Lumpur, MalaysiaTel. +45 62 21 79 12Fax +45 62 20 23 37e-mail: [email protected]

April 1-3, 2009Med-e-Tel

The International eHealth, telemedicine and Health ICT ForumLuxembourgTel. +32 2 269 84 56Fax +32 2 269 79 53e-mail: [email protected]

April 18-21, 2009CMEF Spring 2009

China International Medical

Equipment Fair

Shenzhen, ChinaTel. +86 10 6202 8899 Fax +86 10 8202 2922 e-mail: [email protected]://en.cmef.com.cn

April 18-24, 2009ISMRM 17th Scientific Meeting

& Exhibition International

Society for Magnetic Resonance

in Medicine

Honolulu, Hawaiiwww.ismrm.org/09

June 2-5, 2009Hospitalar 2009

São Paulo, Brazilwww.hospitalar.com/ingles

June 3-6, 2009EFORT Congress 2009

Vienna, AustriaTel. +41 44 448 4400Fax +41 44 448 4411e-mail: [email protected]

June 6-9, 2009Euroanaesthesia 2009

Milan, ItalyTel. +32 2 743 3290Fax +32 2 743 3298e-mail: [email protected] www.euroanesthesia.org

June 8-10, 2009UKRC 2009

Manchester, UKTel. +44 20 7307 1410Fax +44 20 7307 1414e-mail: [email protected]

June 23 - 27, 2009CARS 2009

Berlin, GermanyTel. +49 7742 922 434Fax +49 7742 922 438e-mail: [email protected]

June 24-26, 2009TopClinica - Medical equipment

and solutions

Stuttgart, GermanyTel. +49 711 18560 2312Fax +49 711 18560 2275e-mail: [email protected]

September 16 -18, 2009Medical Fair Thailand 2009

Bangkok, ThailandTel. +65 6332 9620 Fax +65 6332 9655 / 6337 4633e-mail: [email protected]

October 1-3, 2009ESMRMB 2009

Antalya, TurkeyTel: +43 1 535 13 06Fax +43 1 535 70 41e-mail: [email protected]

October 11-14, 2009ESICM 2009

22nd Annual Congress of the European Society of Intensive Care Medicine Vienna, AustriaTel. +32 2 559 03 55 Fax +32 2 527 00 62 e-mail: [email protected]

October 19-22, 2009Jordan International MedExpo 2009

Amman, Jordanwww.me-medexpo.com

November 18-21, 2009MEDICA 2009

Düsseldorf, Germanye-mail: [email protected]

November 29 – December 4, 2009RSNA 2009

Chicago, IL, USAhttp://rsna2009.rsna.org

dates and descriptions of future events have been obtained from

usually reliable official industrial sources. ihe cannot be held responsible

for errors, changes or cancellations.

telemedicine: delivering the evidence

The 7th annual Med-e-Tel conference in Lux-embourg, which will be held from 1st - 3rd April, will focus on proven and tested telemed-icine applications and provide evidence on clinical effectiveness and economic efficiency as well as on user aspects and satisfaction, and on some do’s and don’ts of telemedicine implementation in care processes.The European Health Telematics Association (EHTEL) will be among the contributors to the opening session of this year’s Med-e-Tel conference programme, which will feature additional contributions from the Interna-tional Society for Telemedicine & eHealth, the Russian Telemedicine Association, the Euro-pean Commission, the International Telecom-munication Union and several others that will provide insights into current initiatives and future directions in telemedicine and ehealth.Furthermore, Med-e-Tel 2009 will feature a workshop by the Telenursing Working Group, initiated at last year’s Med-e-Tel, which has been set up within the framework of the Inter-national Society for Telemedicine & eHealth (ISfTeH). The goal of the group is to bring tel-enursing experience to nurses worldwide and enhance networking with key industry stake-holders, by organising sessions and meetings at existing events like Med-e-Tel.A regional (BeLux) hospital administrator seminar, endorsed by the Luxembourg Minis-try of Health and CRP-Santé (Public Research Centre for Health), will focus on “priorities, benefits and budgets for health IT in the 21st

century.” A recurring feature at Med-e-Tel, this

seminar brings together representatives from all major hospitals and other industry stake-holders in Luxembourg as well as various Bel-gian healthcare institutions, and presents busi-ness cases from a number of industry leaders and their clients who draw from successful experiences. This year, the seminar will reflect upon the short and medium term IT priori-ties and on making optimal choices for each individual hospital, each department and the healthcare system as a whole; the seminar will feature some of the most interesting experi-ences in the region and beyond, and show the benefits, as well as the conditions for success and the difficulties and resistance that can be met during implementation.Another important feature will be a work-shop by the European NETC@RDS project, which will focus on the deployment of an online service for the electronic European Health Insurance Card (eEHIC). NETC@RDS’ long-term initiative is to improve access to the healthcare systems in different regions. Currently the project already has installations in 16 European countries.The programme will also include sessions on disease management, services for the ageing, teleconsultation, nursing informatics, open source software, ehealth in developing coun-tries, elearning, mobile solutions, ehealth in primary care, environmental conditions and telehealth, economic efficiency and national ehealth programs and initiatives. Overall, Med-e-Tel promotes and enhances coopera-tion opportunities and is the place to meet and network with some 600 healthcare and industry stakeholders from more than 45 countries in Europe and beyond. More information is available at www.medetel.eu or via [email protected].

For more events see www.ihe-online.com/events/

A91310-8273-A1-4A00 © 03.2009, Siemens Medical Solutions USA, Inc.

Answers for life.

Siemens ACUSON S2000 system. Mastering acoustics toexpand clinical insight.

The ACUSON S2000™ ultrasound system isn't just a step up, it's a giant leap forward. The first in Siemens nextgeneration ultrasound, the ACUSON S2000 system uniquely masters acoustics to expand clinical utility in ways never before possible. Delivering unprecedented image quality, built-in knowledge-based workflow and precisionergonomics, the ACUSON S2000 system is the future of the ultrasound. Now. www.siemens.com/ultrasound

Answers for life.

What is the next dimensionin ultrasound?

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