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Significance of plaque burden using 3D vascular ultrasound in estimating cardiovascular risk

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In a large population study that was the first of its kind, researchers found that an experimental technique known as three-dimensional vascular ultrasound (3DVUS) estimated the quantification of plaque burden (in cubic millimeters) as an important addition to conventional risk factor profile in addressing patient risk stratification.
At an average age of 45 years, they found that the plaque burden in subjects was more than twice as high in men as in women (63.4 cubic millimeters vs. 25.7), and higher in the femoral arteries, and with increasing age.
Researchers explored the bilateral carotid and femoral arteries of 3,860 middle aged participants without prior cardiovascular disease who were employees of the Banco de Santander in Madrid, Spain.  This is an ongoing observational prospective cohort study where participants are being followed up for 10 years. The 3DVUS examinations were performed using a new Phillips iU22 ultrasound system equipped with a VL13-5 3D volume–linear array transducer. This equipment will be available in the near future for routine patient care.
The clinical application of 3DVUS techniques is still at the research and development stage, but there are now a number of clinically promising areas including the measurement of plaque. Direct quantification of atherosclerotic plaque volume by 3DVUS is more reproducible than two-dimensional techniques.
“3DVUS is a feasible, reproducible, and novel imaging technique for quantifying early carotid and femoral atherosclerotic burden in large populations,” said the study’s lead author, Valentin Fuster, MD, PhD, Director of Mount Sinai Heart and Physician-in-Chief of The Mount Sinai Hospital. “This novel method is valid for imaging superficial peripheral atherosclerosis burden from early to advanced stages of disease and can be applied to identification of individuals at risk, targeting or monitoring treatment. Further studies are needed, however, to assess the cost utility of this method compared with others when used in large-scale practice settings and population-based epidemiological studies.”


Icahn School of Medicine at Mount Sinai
icahn.mssm.edu/about-us/news-and-events/mount-sinai-researchers-find-the-significance-of-plaque-burden-using-3d-vascular-ultrasound-in-estimating-cardiovascular-risk

MEDICAL FAIR THAILAND 2017 reflects strong growth of region’s medical industry

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From September 6 – 8, 2017, the Queen Sirikit National Convention Center in Bangkok will again host MEDICAL FAIR THAILAND, 8th International Exhibition on Hospital, Diagnostic, Pharmaceutical, Medical & Rehabilitation Equipment & Supplies.

This year’s edition is set to be its largest, with more than 700 international exhibitors expected. A total of 17 national and country pavilions will present more than 5,000 state-of-the-art medical and healthcare products, equipment and solutions to a targeted audience of 10,000 medical and healthcare professionals. For the first time, Russia, India and the European Union will have country group exhibits at MEDICAL FAIR THAILAND.
 
Organized by Messe Düsseldorf Asia, the subsidiary of Messe Düsseldorf in Germany, MEDICAL FAIR THAILAND 2017 is part of the company’s “World of Medica” portfolio. 
The trade fair is the ideal platform for the dynamic marketplace of Thailand and Southeast Asia. Since its start in 2003, MEDICAL FAIR THAILAND has developed into the region’s No. 1 medical and healthcare event. With every event, the international participation is increasing, reflecting the growth of Thailand and the Southeast Asian region’s medical and healthcare industry.  Leading the first participation at the exhibition with an official Indian national pavilion, Mr. Rajiv Nath from the Forum Coordinator for the Association of Indian Medical Device Industry (AiMED) commented: “MEDICAL FAIR THAILAND 2017 provides Indian companies with an unparalleled opportunity to leverage on the potential of Southeast Asia’s booming medical and healthcare industry. We are excited to be leading our members to this biggest regional platform, to connect and create strong bonds with businesses from around the region and all over the world.” Also debuting at MEDICAL FAIR THAILAND 2017 will be the European Union pavilion. Dr. Michael Pulch, Ambassador, European Union Delegation to Singapore, stated: “This presents an excellent opportunity for European companies specializing in healthcare and medical technologies. As Thailand is one of the leading Southeast Asian countries in the medical technologies industry, the participation of companies from the European Union at MEDICAL FAIR THAILAND 2017 will allow them to reach, connect and network with the right audience.”

Gernot Ringling, Managing Director of Messe Düsseldorf Asia, added: “With Thailand’s dynamic positioning as a leading medical and healthcare hub, which is being further enhanced as the country goes into full gear with Thailand 4.0, value creation and innovation will take centre stage. MEDICAL FAIR THAILAND 2017 will focus on rehabilitative care and connected healthcare, such as digital healthcare equipment and solutions as well as wearable technologies that are rapidly transforming the market. The technologies and innovations on display will contribute to the exhibition’s success as the most important resource and business platform for both international and regional suppliers from the medical and healthcare sectors, bringing together a truly global showcase of the best medical and healthcare devices, services and innovative solutions for both in-and out-patient and rehabilitative care.”

Thailand 4.0, as an economic model, is aiming to transform Thailand into an innovation-driven economy achieving upper-income status – with an emphasis on promoting technology, creativity and innovation in focused industries and changing from a production-based to a service-based economy. The medical and healthcare sectors have been selected alongside ten target industries as growth engines where additional policies will encourage further investment and development in the near future.
 
The exhibits will be complemented by an informative ancillary programme. The Advanced Rehab Technology Conference (ARTeC) 2017 on September 6 & 7 will focus on the theme of “Robotics for Mobility: Quality of Life for the Ageing World.” The conference will explore a series of topics on robotic rehabilitation from analysis to design and intervention, robots for balance and gait training and a symposium on locomotion robotic training for neurorehabilitation. Renowned leaders and industry experts from the U.S., Japan, Singapore and Thailand will participate, including Hermano Igo Krebs, Principal Research Scientist from the Mechanical Engineering Department at MIT. The two-day conference is jointly organized by the Royal College of Physiatrists of Thailand, the Thai Rehabilitation Medicine Association and Messe Düsseldorf Asia. The Dysphagia workshop on September 7 will address difficulties in swallowing – particularly for the elderly and offer evaluation and management programmes, indirect therapies and future rehabilitation treatments.

In addition, comprehensive and user-friendly business matching services dedicated to helping businesses identify and screen potential partners will be available for all exhibitors and visitors to find new partners and suppliers. This free service is particularly useful for companies looking to expand their business in the Southeast Asian region or to connect with international companies.

www.medicalfair-thailand.com

New skin-graft system a better fix for chronic wounds

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According to the National Institutes of Health, more than six million cases of chronic wounds cost $20 billion ( Euro 17.8 billiion) each year in the United States. Diabetic ulcers, pressure sores, surgical site wounds and traumatic injuries to high-risk patients account for most wounds that won’t heal. However, data from a University of Missouri School of Medicine study indicates that a recently developed skin-graft harvesting system aids in chronic wound recovery and reduces care costs by accelerating the healing process.
‘Chronic wounds occur when healing fails to progress normally and persists for more than 30 days,’ said Jeffrey Litt, DO, assistant professor of surgery at the MU School of Medicine and lead author of the study. ‘Current treatments such as moist dressings, frequent irrigations and wound cleaning are not always enough to ensure that healing occurs in high-risk patients. Although a skin graft can be used to close a wound that refuses to heal, the surgical technique usually is painful, time-consuming and leaves significant donor site wounds.’
Split-thickness skin grafting currently is the gold standard for treating traumatic and burn injury-related skin loss. The surgical procedure involves removing the top two layers of skin from a healthy donor site, and transplanting the tissue to an injured area. However, split-thickness grafting must be performed in an operating room and the technique is limited by the availability of donor skin. Additionally, donor sites usually are large, painful and also can become chronic wounds.
In the study, Litt’s team at MU Health Care used a recently developed autograft harvesting system to care for 13 patients with various types of chronic wounds. The new technology, which Litt’s team did not develop, was used to harvest only the top layer of skin for much smaller, consistently sized donor grafts. The minimally invasive approach, performed in an outpatient clinic setting, also resulted in much less donor site damage and little to no pain. Following the patients’ care, clinical outcomes and costs were evaluated.
‘Eight of the 13 high-risk patients treated with the autograft system experienced much faster healing of their chronic wounds,’ said Litt, who also serves as medical director of MU Health Care’s burn and wound programme. ‘Four of these patients fully healed in less than one month. Additionally, the comparatively rapid closure of the open wounds also reduced healthcare costs by an average of $1,153 ( Euro 1,026) per patient and $650 ( Euro 580) to the burn and wound programme.’
Litt’s team noted that the accelerated healing also resulted in no wound recurrence – a complication associated with at-risk patient populations.

University of Missouri School of Medicine http://tinyurl.com/ydyhjkeb

Adding abiraterone to standard treatment improves prostate cancer survival by 40 per cent

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Adding abiraterone to hormone therapy at the start of treatment for prostate cancer improves survival by 37 per cent, according to the results of one of the largest ever clinical trials for prostate cancer presented at the 2017 ASCO Annual Meeting (link is external) in Chicago.

The results from the Cancer Research UK-funded STAMPEDE trial could change the standard of care for men with prostate cancer, making abiraterone a first-line treatment alongside hormone therapy.

This part of the STAMPEDE trial recruited around 1,900 patients. Half the men were treated with hormone therapy while the other half received hormone therapy and abiraterone. In men who were given abiraterone there was a 70 per cent reduction in disease progression.

The drug is usually given to men with advanced prostate cancer that has spread and has stopped responding to standard to hormone therapy, but this study shows the added benefit to patients who are about to start long-term hormone therapy.

Professor Nicholas James, chief investigator of the Cancer Research UK-funded STAMPEDE trial from the University of Birmingham, said: ‘These are the most powerful results I’ve seen from a prostate cancer trial – it’s a once in a career feeling. This is one of the biggest reductions in death I’ve seen in any clinical trial for adult cancers.

‘Abiraterone is already used to treat some men whose disease has spread but our results show many more could benefit. In addition to the improvements in survival and time without relapse, the drug reduced the rates of severe bone complications, a major problem in prostate cancer, by more than a half. I really hope these results can change clinical practice.’

Prostate cancer cells usually depend on testosterone to grow. Standard hormone therapy blocks the action of male sex hormones, halting the disease. Abiraterone goes further and shuts down the production of the hormones that fuel prostate cancer’s growth.

Each year around 46,500 men are diagnosed with prostate cancer in the UK, and around 11,000 men die from the disease.

Sir Harpal Kumar, Cancer Research UK’s chief executive, said: ‘These results could transform the treatment of prostate cancer. Abiraterone can clearly help many more prostate cancer patients than was first thought.

Cancer Research UK www.cancerresearchuk.org/about-us/cancer-news/press-release/2017-06-03-adding-abiraterone-to-standard-treatment-improves-prostate-cancer-survival-by-40-per-cent

Research uncovers life-saving benefits in the battle against viruses

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At-risk patients, such as those with HIV or transplant recipients, could benefit from potentially life-saving study carried out by a University of Surrey led group of international researchers.

The research, led by Professor Vince Emery, Senior Vice-President (Global Strategy and Engagement) and Professor of Translational Virology at the University of Surrey, has developed a model that will provide vital insight into how best to help patients with Cytomegalovirus (CMV) infection, particularly those who have undergone organ transplantation.

CMV can be serious if the patient’s immune system is not fully functioning, as in transplant patients on immune-suppressant drugs, or for HIV patients in the advanced stages of AIDS. In these cases, CMV can cause major health problems, affecting a range of organs and contributing to early death, which obviously makes it vital to understand how to control the virus.

The mainstay of therapy for CMV has been an antiviral drug called Ganciclovir, which mimics the building blocks of DNA and stops the virus from replicating.

In the current study, the researchers used information from a large clinical trial of Ganciclovir for the treatment of CMV disease in patients who had undergone solid organ transplantation, to assess the patterns of viral responses seen following therapy.

This is the first time that a comprehensive model has been developed which explains the full range of post-therapy virus decline patterns. It provides vital insight into how to best help patients with CMV infection, especially after solid organ transplants and is potentially extendable to stem cell transplant patients.

The researchers have identified four unique patterns of response and have then used this to develop a sophisticated mathematical model which can accurately account for these patterns of decline.

The researchers’ work also benefits patients by leading the way forward to personalised medicine, and will make it possible to predict the likely duration of therapy needed for a patient with CMV infection to clear the virus.

Professor Emery said: ‘I am very proud to have led this vital research, as it will improve the health and quality of life of patients with CMV infection. CMV is a member of the herpes virus family and related to the virus that causes cold sores; these viruses are widespread and usually harmless.

‘But in some at risk cases, such as when the patients’ immune system is not fully functioning, it could mean the difference between life and death.

University of Surrey www.surrey.ac.uk/mediacentre/press/2017/research-uncovers-life-saving-benefits-battle-against-viruses

First global guidance for HPV vaccination for cervical cancer prevention

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The American Society of Clinical Oncology (ASCO) hasissued a clinical practice guideline on human papillomavirus (HPV) vaccination for the prevention of cervical cancer. This is the first guideline on primary prevention of cervical cancer that is tailored to multiple regions of the world with different levels of socio-economic and structural resource settings, offering evidence-based guidance to health care providers worldwide.

The guideline includes specific recommendations according to four levels of resource settings: basic, limited, enhanced and maximal. The levels pertain to financial resources of a country or region, as well as the development of its health system – including personnel, infrastructure and access to services. The guideline complements ASCO’s two other global, resource-stratified guidelines on cervical cancer, also stratified to these four levels of resources.

Key guideline recommendations:

  • In all environments and independent of the resource settings, two doses of human papillomavirus vaccine are recommended for girls ages 9 to 14 years, with an interval of at least 6 months and up to 12 to 15 months between doses.
  • Girls who are HIV positive should receive three doses.
  • For maximal and enhanced resource settings:
    • If girls are 15 years or older and have received their first dose before age 15, they may complete the two-dose series;
    • If they have not received the first dose before age 15, they should receive three doses;
    • In both scenarios vaccination may be given through age 26 years.
  • For limited and basic resource settings: if sufficient resources remain after vaccinating girls 9 to 14 years, girls who received one dose may receive additional doses between ages 15 and 26 years.
  • Vaccination of boys: in all settings, boys may be vaccinated, if there is at least a 50percent coverage in priority female target population, sufficient resources, and such vaccination is cost effective.

Cervical cancer is the fourth most common cancer among women worldwide, with less developed regions suffering a disproportionate burden from the disease. In fact, 85percent of cervical cancer diagnoses and 87percent of cervical cancer deaths occur in less developed regions, including parts of Africa and Latin America.

‘Because resource availability varies widely, both among and within countries, we need to adjust strategies to improve access to HPV vaccination everywhere,’ said Silvia de Sanjose, MD, PhD, co-chair of the Expert Panel that developed the guideline and head of the Cancer Epidemiology Research Program at Institut Catala d’Oncologia in Barcelona, Spain. ‘This guideline is unique in offering cervical cancer vaccination recommendations that can be adapted to different resource levels and we expect it to have a major impact on the global health community.’

ASCO www.asco.org/about-asco/press-center/news-releases/first-global-guidance-hpv-vaccination-cervical-cancer

Hospitals that spend more on emergency care yield better outcomes

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Hospitals that spend more on initial care following patient emergencies have better outcomes than hospitals that spend less at first and rely more on additional forms of long-term care, according to a new study co-authored by MIT economists.
More specifically, hospitals that invest more in inpatient care yield better results, per dollar spent, than those that assign relatively more patients to skilled nursing facilities upon discharge. Other things being equal, allocating a higher percentage of overall health care expenses to a hospital’s inpatient treatment is consistent with lower mortality rates among elderly Medicare recipients.
“We find that patients who go to hospitals that rely more on skilled nursing facilities after discharge, as opposed to getting them healthy enough to return home, are substantially less likely to survive over the following year,” says Joseph Doyle, the Erwin H. Schell Professor of Management at the MIT Sloan School of Management and co-author of a paper detailing the study.
Conversely, Doyle adds: “What types of hospitals are low-cost and have good outcomes? They spend a lot when you’re there, initially, but a lot less [after] you leave the hospital.”
The co-authors are Doyle; John A. Graves, an assistant professor at Vanderbilt University; and Jonathan Gruber, the Ford Professor of Economics at MIT.
The study aims, in part, to address the fact that the U.S. spends about 40 percent more on health care per capita than the next highest-spending country in the Organisation for Economic Co-operation and Development (OECD), a group of 35 major nations — a figure that leads many to wonder whether there are significant ineffeciencies in U.S. health care spending.
In devising their experiment, the researchers took advantage of ambulance company practices that essentially provided a randomized group of patients to study, making it possible to compare outcomes at different hospitals.
The study uses Medicare claims data for hospital admissions from 2002 to 2011, focusing on patients who were at least 66 years old, and tracking their one-year mortality statistics. The study’s final database comprised 1,575,273 patients.
In many parts of the U.S., multiple ambulance companies cover a given area, and their assignment to patients is essentially random; the first available company will take a patient. However, ambulance companies often have agreements or preferences concerning which hospitals they deliver patients to. That means the ambulance companies are essentially delivering a randomized set of people to certain hospitals.
For this reason, the study avoids a basic problem in comparing hospital outcomes — that patients admitted to one hospital may be significantly less healthy, on average, than the patients admitted to another. All told, there are about 2,500 ambulance companies and about 3,000 hospitals in the data set.
The average 90-day spending on patients in the study is almost $27,500; for every additional increase in spending of roughly $8,500, the researchers found a reduction in mortality risk of about 2 percentage points. However, the study finds about a 5 percentage-point increase in mortality at hospitals that have relatively high rates of spending on “downstream” nursing facilities.
“We see this as a potentially novel quality measure for hospitals,” Doyle says. “Hospitals that have that profile where they send patients to skilled nursing facilities have higher spending downstream, and they have worse outcomes.”
The paper is one of a series of studies by Doyle and his colleagues which use the random assignment of patients to hospitals, due to ambulance-dispatch practices, in order to evaluate hospital effectiveness. In a previous study more strictly focused on the intensity of emergency care treatments, Doyle also found that higher spending leads to better outcomes.

MIT
news.mit.edu/2017/hospitals-spend-more-emergency-care-yield-better-outcomes-0710

B. Braun and Philips join forces to innovate in ultrasound-guided regional anesthesia and vascular access

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B. Braun Melsungen AG, active in regional anesthesia and pain management, and Royal Philips, a global leader in ultrasound and image-guided therapy solutions, recently announced a multi-year strategic alliance to innovate ultrasound-guided regional anesthesia – a rapidly growing alternative to general anesthesia – and vascular access. Leveraging the companies’ combined deep clinical expertise and R&D capabilities, as well as sales and service channels, B. Braun and Philips are jointly developing and commercializing solutions to support anesthesiologists and hospitals in critical areas of regional anesthesia. These solutions are intended to enhance needle visualization and guidance, as well as optimize procedure workflow and resource planning. The alliance will also focus on vascular access procedures, such as those used to insert catheters into deeply seated veins as part of a catheter-based treatment.
As a platform on which to implement their joint innovations, Philips and B. Braun are launching the new Xperius ultrasound system, which will be available in a cart and ultra-mobile tablet version. Based on the input of clinical experts, Xperius was specifically designed to support the needs in regional anesthesia at the point of care. The system offers an intuitive user interface and exceptional image quality for confident needle targeting and positioning, as well as ergonomic features such as the articulating arm.
Xperius complements B. Braun´s innovative offering in the field of ultrasound guided regional anesthesia which includes the newly launched peripheral nerve block portfolio comprising Stimuplex® and Contiplex® Ultra 360®. It has also been specifically designed to support future innovations for needle visualization and guidance. The two companies will offer education, training, service and support that will enable anesthesiologists and healthcare providers to extract maximum benefit from the system.
Regional anesthesia or analgesia involves the injection of an anesthetic in the proximity of a nerve, targeting areas of a patient’s body that are subject to surgical intervention. Regional anesthesia can have significant advantages over general anesthesia for both patients and hospitals. Patients undergoing regional anesthesia typically benefit from reduced opioid consumption and fewer side-effects, such as nausea. Moreover, regional anesthesia may lead to faster post-surgical recovery, allowing patients to ambulate or leave the hospital sooner, which benefits both patients and hospitals.
However, regional anesthesia and especially peripheral nerve blocks are not easy to perform. Maximizing anesthetic effectiveness and preventing damage to the targeted nerve or other tissue structures depends on the accurate placement of the needle tip through which the anesthetic will be injected or a catheter will be placed. Hence, there is a real need for innovations that continually improve the safety, effectiveness, and efficiency of regional anesthesia procedures.
“Our customers are looking for fully integrated system solutions that address all aspects of their everyday work in caring for patients, including the enhanced efficiency needed to meet ever-increasing demand for their services,” said Dr. Meinrad Lugan, Member of the Board for the Hospital Care Division at B. Braun. “This new alliance with Philips illustrates our commitment to sharing expertise, not only with our customers, but also with other key technology players, to meet healthcare needs and challenges faced today and into the future.”
“Philips and B. Braun have a worldwide reputation for clinical innovations and a shared commitment to work with patients and care providers to optimize healthcare delivery and improve patient outcomes,” said Rob Cascella, Chief Business Leader of the Diagnosis & Treatment Businesses at Philips. “By partnering with B. Braun, we have created a solution for ultrasound-guided regional anesthesia comprising the Xperius ultrasound system, decision support software, echogenic needles, and a suite of services. We look forward to jointly developing further innovations. This new alliance is a great example of our commitment to partnering with industry leaders with complementary skills to increase our footprint in the therapy market.”
The Xperius platform will be co-branded and sold via B. Braun’s global sales network, with Philips providing installation and service.

www.philips.com      www.bbraun.com

Brain-computer interface allows completely locked-in people to communicate

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A brain-computer interface that can decipher the thoughts of people who are unable to communicate could revolutionize the lives of those living with complete locked-in syndrome. Counter to expectations, the participants in the study reported being ‘happy’ despite their condition.
In the trial, people with complete locked-in syndrome, who were incapable of even moving their eyes to communicate, were able to respond ‘yes’ or ‘no’ via thought to spoken questions. A non-invasive brain-computer interface (BCI) detected their responses by measuring changes in blood oxygen levels in the brain.
The results overturn previous theories that people with complete locked-in syndrome lack the goal_directed thinking necessary to use a brain computer interface and are therefore incapable of communication.
Extensive investigations were carried out in four people with ALS (amyotrophic lateral sclerosis) – a progressive motor neuron disease that leads to complete destruction of the part of the nervous system responsible for movement.
The researchers asked personal questions with known answers and open questions that needed ‘yes’ or ‘no’ answers including: ‘Your husband’s name is Joachim?’ and ‘Are you happy?’. They found the questions elicited correct responses seven times out of ten.
Professor Niels Birbaumer, a neuroscientist at the Wyss Center for Bio and Neuroengineering in Geneva, senior author of the paper said: ‘The striking results overturn my own theory that people with complete locked-in syndrome are not capable of communication. We found that all four people we tested were able to answer the personal questions we asked them, using their thoughts alone. If we can replicate this study in more patients I believe we could restore useful communication in completely locked-in states for people with motor neuron diseases.’
The question ‘Are you happy?’ resulted in a consistent ‘Yes’ response from the four people, repeated over weeks of questioning.
Professor Birbaumer said: ‘We were initially surprised at the positive responses when we questioned the four completely locked-in participants about their quality of life. All four had accepted artificial ventilation in order to sustain their life when breathing became impossible so, in a sense, they had already chosen to live. What we observed was as long as they received satisfactory care at home, they found their quality of life acceptable. It is for this reason, if we could make this technique widely clinically available, it would have a huge impact on the day-to-day life of people with complete locked-in syndrome’.

Wyss Center http://tinyurl.com/j7plj5n

Combined optical and molecular imaging could guide breast-conserving surgery

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Breast-conserving surgery (BCS) is the primary treatment for early-stage breast cancer, but more accurate techniques are needed to assess resection margins during surgery to avoid the need for follow-up surgeries. Now, in a first-in-human study, British researchers have provided a possible solution using Cerenkov luminescence imaging (CLI), which combines optical and molecular imaging by detecting light emitted by the PET radiotracer F-18-fluorodeoxyglucose (F-18-FDG). CLI’s high-resolution and small-sized imaging equipment make it a promising technology for assessing tumour margins during breast tumour surgery.

‘Currently, approximately 1 in 5 women who undergo breast-conserving surgery, also known as lumpectomy, require repeat surgery due to inadequate excision of the tumour during the initial surgical procedure,’ explains Arnie D. Purushotham, MD, professor at King’s College London, UK. ‘By accurately assessing tumour resection margins intraoperatively with CLI, surgeons may be able to completely clear the cancer with a single operation, thereby reducing the number of breast cancer patients requiring a second, or even third, surgical procedure. Ultimately this could lead to improved patient care and reduced healthcare costs if confirmed in larger clinical studies.’

This study included 22 patients with invasive breast cancer. F-18-FDG was injected 45-60 minutes before surgery. Immediately after the excision of tumours, specimens were imaged intraoperatively in an investigational CLI imaging system. The first 10 patients were used to optimize the imaging protocol; the remaining 12 were included in the analysis dataset. Ten of the 12 patients had an elevated tumour radiance on CLI, and agreement among raters on margin distance was good. Sentinel lymph nodes, which used technetium-99m to facilitate identification, were successfully detected and biopsied in all patients.

F-18-FDG CLI is, therefore, a promising, low-risk technique for intraoperative assessment of tumour margins in breast-conserving surgery. A randomized controlled trial will evaluate the impact of this technique on re-excision rates.

Purushotham points out, ‘The feasibility of intraoperative CLI as shown in this study, in combination with the wide applicability of F-18-FDG across a range of solid cancers, provides a stepping stone for clinical evaluation of this technology in other solid cancer types that also experience incomplete tumour resection due to close or involved margins.’ He also notes, ‘CLI offers the ability to image clinically approved and widely used PET tracers intraoperatively by using small-sized imaging equipment, thus expanding the field of traditional nuclear medicine.’

EurekAlert www.eurekalert.org/pub_releases/2017-06/sonm-coa060117.php

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