Технологии Fusion при исследовании мышечно-скелетной системы

Diagnostic capabilities of a new hybrid computer technology named Fusion in musculo-skeletal applications which provides a combined use of X-ray, scintigraphy, CT, PET, MRI with US are discussed in the issue. Questions of combined use of Fusion with Doppler, contrast enhancement and elastography are reviewed. Advantages of the Fusion technology in examination of different parts of musculo-skeletal system are clearly showed. Diagnostic capabilities of Fusion technology using US-device My Lab Class C (ESAOTE) with a special virtual navigator module was studied for hip, knee, shoulder joints. Combination of X-ray, MSCT and MRI images before planning surgery and after, and in rehabilitation period were performed in 16 patients. Possibilities of Fusion technology in evaluation of different joint’s elements was carefully illustrated.В статье обсуждаются возможности применения новой гибридной компьютерной технологии фьюжн (Fusion) для исследований мышечно-скелетной системы, предусматривающие сочетанное использование рентгенографии, сцинтиграфии, КТ, МРТ с УЗИ. Рассматриваются вопросы сочетанного использования Fusion с методиками допплеровского картирования, контрастного усиления и эластографии. Наглядно продемонстрированы преимущества методики Fusion при исследовании различных отделов мышечно-скелетной системы. Проводилась оценка возможностей технологии Fusion на аппарате My Lab Class C (Esaote), оснащенном модулем виртуальной навигации для исследования тазобедренного, коленного, плечевого суставов. Проводилось слияние изображений цифрового рентгенографического, МСКТ и МРТ у 16 пациентов амбулаторно и перед планируемой операцией, а также в реабилитационном периоде. Наглядно проиллюстрированы возможности технологии Fusion при исследовании капсульно-связочного аппарата различных суставов и околосуставных отделов

IMAGING DI FUSIONE E NUOVE TECNOLOGIE ABLATIVE IN ONCOLOGIA INTERVENTISTICA

Le terapie oncologiche interventistiche stanno entrando sempre più nella pratica clinica quali efficaci terapie alternative o complementari per molte malattie tumorali. Tali terapie, per definizione mini-invasive, sono effettuate sotto la guida delle metodiche per immagine. L’imaging di fusione consente di allineare e sovrapporre in tempo reale le immagini ottenute mediante metodiche diverse, allo scopo di sfruttare al meglio le caratteristiche di ognuna, superandone i rispettivi limiti. La prima fase del progetto ha dimostrato la fattibilità e la accuratezza della guida di procedure interventistiche mediante un sistema di fusione di immagini di tomografia computerizzata e ultrasuoni in un modello ex-vivo. Nella seconda e terza fase del progetto sono state valutate fattibilità e sicurezza di nuove procedure ablative per il trattamento di neoplasie polmonari, in un modello animale in-vivo. Nella seconda fase sono stati trattati con successo e senza complicanze 10 conigli New Zealand White, mediante agoelettrodo ad uncini per fusi. Nella terza fase è stata dimostrata la fattibilità e sicurezza della termoablazione polmonare mediante micro-onde in 10 conigli New Zealand White , paragonando i risultati con quelli ottenuti in un gruppo di 10 animali trattati con la termoablazione a radiofrequenza

A novel software platform for volumetric assessment of ablation completeness

Purpose: To retrospectively evaluate the accuracy of a novel software platform for assessing completeness of percutaneous thermal ablations. Materials & methods: Ninety hepatocellular carcinomas (HCCs) in 50 patients receiving percutaneous ultrasound-guided microwave ablation (MWA) that resulted in apparent technical success at 24-h post-ablation computed tomography (CT) and with ≥1-year imaging follow-up were randomly selected from a 320 HCC ablation database (2010–2016). Using a novel volumetric registration software, pre-ablation CT volumes of the HCCs without and with the addition of a 5 mm safety margin, and corresponding post-ablation necrosis volumes were segmented, co-registered and overlapped. These were compared to visual side-by-side inspection of axial images. Results: At 1-year follow-up, CT showed absence of local tumor progression (LTP) in 69/90 (76.7%) cases and LTP in 21/90 (23.3%). For HCCs classified by the software as "incomplete tumor treatments", LTP developed in 13/17 (76.5%) and all 13 (100%) of these LTPs occurred exactly where residual non-ablated tumor was identified by retrospective software analysis. HCCs classified as "complete ablation with <100% 5 mm ablative margins" had LTP in 8/49 (16.3%), while none of 24 HCCs with "complete ablation including 100% 5 mm ablative margins" had LTP. Differences in LTP between both partially ablated HCCs vs completely ablated HCCs, and ablated HCCs with <100% vs with 100% 5 mm margins were statistically significant (p < .0001 and p = .036, respectively). Thus, 13/21 (61.9%) incomplete tumor treatments could have been detected immediately, were the software available at the time of ablation. Conclusions: A novel software platform for volumetric assessment of ablation completeness may increase the detection of incompletely ablated tumors, thereby holding the potential to avoid subsequent recurrences

Development of probes for molecular imaging : evaluation in models of inflammation and atherosclerosis

The imaging field is rapidly evolving and in the last two decades there have been tremendous developments in the field of multimodal imaging. Multimodal molecular imaging approaches that utilize ultrasound/magnetic resonance imaging (US/MRI), single-photon emission computed tomography/computed tomography (SPECT/CT), or positron emission tomography/MRI (PET/MRI) may provide additional detailed information at the cellular and molecular level to help identify patients with vulnerable plaques that are at risk of rupture. The search for specific biomarkers in combination with specific and optimized molecular probes may help to prevent adverse events such as myocardial infarctions or strokes. Current clinical contrast agents do not provide information on the inflammatory components of atherosclerotic plaques; thus, more specific molecular probes are needed. This thesis focuses on probe development for different molecular imaging techniques using multimodal and targeting approaches. Several types of molecular probe were evaluated: bimodal and multimodal microbubbles, as well as chemically modified human serum albumin (HSA)-based probes (aconitylated (Aco) and maleylated (Mal)) for targeting markers of inflammation; adhesion molecules on endothelial cells or macrophages, and scavenger receptor A1 (SR-A1) on macrophages. Evaluation of these molecular probes was facilitated by their physical properties enabling assessment with fluorescence microscopy, flow cytometry, and nuclear imaging properties for in vivo molecular imaging with SPECT/CT and PET/MRI. We found that functionalizing molecular probes with targeting moieties greatly improved the targeting specificity and avidity to the target compared to non-targeted molecular probes. Furthermore, these molecular probes were successfully radiolabeled with a detectable in vivo signal by 99mTc-anti-ICAM-1- MBs imaging of inflammation with SPETC/CT, and atherosclerosis by 89Zr-Mal-HSA with PET/MRI. Ex vivo evaluation of HSA-based probes showed significant accumulation in atherosclerotic lesions of Apoe-/- mice, as quantified by gamma counter and phosphor imaging autoradiography, compared to wild type (WT) mice. In conclusion, adhesion molecule targeting and scavenger receptor targeting with functionally modified probes in this thesis showed potential for the imaging of inflammation and atherosclerosis. Of the evaluated probes, modified HSA-based probes seem to have the greatest potential for clinical application in molecular imaging of atherosclerosis

Computer- and robot-assisted Medical Intervention

Medical robotics includes assistive devices used by the physician in order to make his/her diagnostic or therapeutic practices easier and more efficient. This chapter focuses on such systems. It introduces the general field of Computer-Assisted Medical Interventions, its aims, its different components and describes the place of robots in that context. The evolutions in terms of general design and control paradigms in the development of medical robots are presented and issues specific to that application domain are discussed. A view of existing systems, on-going developments and future trends is given. A case-study is detailed. Other types of robotic help in the medical environment (such as for assisting a handicapped person, for rehabilitation of a patient or for replacement of some damaged/suppressed limbs or organs) are out of the scope of this chapter.Comment: Handbook of Automation, Shimon Nof (Ed.) (2009) 000-00

Entwicklungen und Untersuchungen zur Bildgebung der Schilddrüse: 124Iod-PET/CT, 3D-Ultraschall und nuklearmedizinisch-sonographische Bildfusion

In der etablierten Schilddrüsenbildgebung existieren trotz des bereits hohen Standards begrenzende Faktoren. Methodische und technische Neuerungen erscheinen mithin sinnvoll und geboten. Die vorliegende Habilitationsschrift stellt die Entwicklung und Erprobung neuer Konzepte der Schilddrüsendiagnostik in drei Teilgebieten vor: *Durch die 124Iod-Niedrigaktivitäts-PET/Niedrigdosis-CT wird (i) die Ortsauflösung der herkömmlichen Szintigraphie übertroffen und die Detektierbarkeit kleinerer Strukturen sowie anatomischer Details verbessert. Durch den parallel akquirierten CT-Datensatz können (ii) zusätzliche Erkenntnisse zur Schilddrüse sowie deren Beziehung zu Nachbarorganen gewonnen werden. Darüber hinaus sind (iii) im Rahmen der Vorbereitung von Radiojodtherapien prätherapeutische Uptake-Messungen möglich. *Der 3D-US ermöglicht (i) den lückenlosen Scan der Schilddrüse und (ii) die vollständige digitale Archivierung des Untersuchungsvolumens im PACS. Dadurch ergeben sich auf Schnittbildworkstations die Vorteile (iii) des Second Readings, (iv) des Side-by-Side-Vergleichs mit vorangegangenen 3D-US-Studien und anderen Schnittbildverfahren. Darüber hinaus kann (v) eine nachträgliche Datenverarbeitung (Processing) erfolgen. *Die Einbeziehung des Ultraschalls in das Konzept der Fusions- bzw. Hybridbildgebung hat gezeigt, dass die räumliche Verknüpfung und bildliche Überlagerung der morphologisch-sonographischen Informationen mit den nuklearmedizinisch-funktionellen Bilddaten erfolgen kann. Aus dem klinischen Potential der Methoden einerseits, sowie den geschilderten Limitationen andererseits ergeben sich Implikationen für die Zukunft. Zunächst sind die apparativ-technische Weiterentwicklung der Verfahren sowie eine Optimierung der informationstechnischen Einbindung notwendig. Darüber hinaus muss eine Entwicklung hin zu einer zeitsparenden und einfachen Anwendbarkeit erfolgen, um einen rationellen klinischen Workflow zu ermöglichen und personelle Ressourcen zu schonen

Diagnostic value of nuclear cardiology in coronary artery disease

This thesis investigates the diagnostic value of cardiac positron emission tomography when compared to single photon emission computed tomography for detection of coronary artery disease. This prospective study involves comparison of myocardial perfusion single photon emission computed tomography with coronary calcium scores; optimization of nuclear cardiac protocols in cardiac phantom experiments; and determination of diagnostic performance of cardiac positron emission tomography in the evaluation of myocardial viability in patients with significant coronary disease

Engineering precision surgery: Design and implementation of surgical guidance technologies

In the quest for precision surgery, this thesis introduces several novel detection and navigation modalities for the localization of cancer-related tissues in the operating room. The engineering efforts have focused on image-guided surgery modalities that use the complementary tracer signatures of nuclear and fluorescence radiation. The first part of the thesis covers the use of “GPS-like” navigation concepts to navigate fluorescence cameras during surgery, based on SPECT images of the patient. The second part of the thesis introduces several new imaging modalities such as a hybrid 3D freehand Fluorescence and freehand SPECT imaging and navigation device. Furthermore, to improve the detection of radioactive tracer-emissions during robot-assisted laparoscopic surgery, a tethered DROP-IN gamma probe is introduced. The clinical indications that are used to evaluate the new technologies were all focused on sentinel lymph node procedures in urology (i.e. prostate and penile cancer). Nevertheless, all presented techniques are of such a nature, that they can be applied to different surgical indications, including sentinel lymph node and tumor-receptor-targeted procedures, localization the primary tumor and metastatic spread. This will hopefully contribute towards more precise, less invasive and more effective surgical procedures in the field of oncology. Crystal Photonics GmbH Eurorad S.A. Intuitive Surgical Inc. KARL STORZ Endoscopie Nederland B.V. MILabs B.V. PI Medical Diagnostic Equipment B.V. SurgicEye GmbH Verb Surgical Inc.LUMC / Geneeskund