Last February, a group of Canadian researchers presented at the American Academy of Orthopeadic Surgeons (AAOS) a new study about the interpretation of MR images on the iphone.

Smartphones are becoming part of every activity of our lives, and this is also true for physicians and hospitals. The advantage is that they are portable and most of the time on the pocket or handbag, but the question is whether they are good enough for a medical diagnosis.

According to Dr. John Theodoropoulos, an orthopedic surgeon from the University of Toronto, “iPhone interpretations showed high sensitivity and specificity for medial meniscus and cruciate ligaments injuries with lower sensitivity for lateral meniscus tears and lower specificity for cartilage injuries.  And compared to much larger the PACS workstation interpretation on a flat screen, the iPhone showed excellent agreement for medial meniscus and cruciate ligament injuries and good agreement for cartilage injuries”. However, Dr. Theodoropoulos said that the iPhone app missed two cartilage tears versus the full-sized workstation.

Maybe we are not there yet, but the smartphones and tablets certainly look promising for medical image interpretation and have many features that make them very attractive, specially for emergency cases.

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An MR scan in 5 minutes?

September 1, 2011

Imagine you could do an MR scanner in 5 minutes and get all the image types that you need.
SyntheticMR offers a product called SyMRI that does just that: “On the MR scanner a special sequence is introduced that results in the measurement of the absolute MR parameters.Based on these parameters T1- and T2-weighted image can be generated without rescanning. As each tissue has its own unique combination of parameters, the anatomy can automatically be segmented into various tissue components”.
The quantification scan is a multi-slice, multi-echo, multi-saturation delay sequence that is able to retrieve T1 and T2 relaxation, proton density and the B1 field in one scan.
Whether this is the future of MRI, only time and clinical studies will tell, but it looks promising.

Microsoft Research has come up with a virtual tool for physiotherapy. The idea behind it is to motivate people recovering from injuries to do their exercises. AnatOnMe is a device that projects images of the bones muscles and ligaments inside the body onto the patient’s own skin. This is a novel implementation of augmented reality as the augmented world is projected on the patient. An image of the underlying bone structure, muscle tissue, tendons, or nerves is projected onto the skin, giving patients a better understanding of the injury, and of what they need to do to help the healing process.
The device consists of two parts: the first one contains a projector, an ordinary digital camera, and an infrared camera. The second contains a laser pointer and the control buttons. The system is not meant to be very accurate, and the image of the internal injury is not precisely map onto the patient’s exterior, the therapist simply points the projector and lines it up by eye. The images displayed are not actually taken from scans of the patients but come from stock graphical images used to show one of six different types of injury. However, it works pretty well to educate patients and help them better understand their injuries.

Open or Wide Bore MR?

May 25, 2011

That’s the question researchers from Germany try to answer in the CLAUSTRO trial (start Feb 2011). According to the authors: “The goal is to analyze the rate of claustrophobic reactions and clinical utility of an open MR scanner in a randomized comparison with a recently designed short-bore but closed scanner with 97% noise reduction. This trial will be the first to appraise the potential for claustrophobia reduction and clinical relevance of open MR scanners in claustrophobic patients with a clinical indication for MR imaging. Furthermore, this trial will analyze and compare the cost-effectiveness of the two MR scanners, which is important in view of the enormous annual loss of healthcare productivity due to claustrophobia during MR imaging. Also, patient preferences and image quality will be analyzed. Thus, this randomized trial may have the potential to influence both the clinical and economical utilization of MR imaging.”
This is a very interesting trial that will yield a comparison between the two systems from a patient point of view, which is very important. The success of a good MR scan depends a lot on how comfortable the patient feels, given the fact that he/she has to lie still for quite some time.
For more information, please refer to: Reduction of claustrophobia during magnetic resonance imaging: methods and design of the “CLAUSTRO” randomized controlled trial

3T MRI in pediatrics

May 17, 2011

3T MRI is being increasingly performed for clinical purposes. The increased SNR is a significant advantage in pediatrics – improved spatial and temporal resolution assist in overcoming the major anatomic, physiologic and behavioural challenges of imaging children. 3T MRI has the potential to image all the systems in pediatrics. However, optimising the parameters with due consideration to specific pediatric features, such as the increased water content of non myelinated brain, is essential. The neonatal brain and pediatric spine are difficult to image at 3T. Several factors also limit cardiac imaging at present. Further improvements in coil technology and newer sequences may help overcome the challenges that remain. On the other hand, some 3T artefacts inherent to specific anatomic regions, like the dielectric effects encountered in adult abdominal imaging, are less problematic in pediatrics due the smaller size.
For more information, see this white paper

Anyone that has worked with ultrasound imaging knows how difficult it is to recognise structures with the naked eye. Training and experience play a very important role in interpreting those images, and, most importantly, in recognising anomalities.
A recent study by researchers from California has shown that detailed instruction in obtaining 3DUS images of fetal profiles improved the image quality obtained by phisicians. Teaching physicians in a standardized way may help improve the use of 3DUS in clinical practice for a broader spectrum of pathologies: for instance, in image guidance for radiotherapy & brachytherapy in gyneacology, breast, prostate and other cancer types.

Researchers from the Mechanical, Aerospace and Nuclear Engineering, Rensselaer Polytechnic Institute, Troy, NY USA have developed an algorithm that makes use of the elasticity properties of tissues to characterize malignant tumors. They use an ultrasound device and they process the radiofrequency data to reconstruct the linear and non-linear elasticity properties of tissue, by calculating the displacement within the tissue and mapping the spatial distribution with the material properties that would give that displacement. In order to measure the non-elasticity properties, the tissue needs to be deformed up to 20%, which limits the areas of application of this technology. Currently, they are investigating atherosclerosis disease and skin cancer, besides breast.
For more information, please refer to the published article