Biomedical engineers at the University of California, Davis, have developed a new technique for measuring blood flow in the human brain, which could be used in patients with stroke or traumatic brain injury, for example. The new technique, based on conventional digital camera technology, could be significantly cheaper and more robust than prior methods.
“Our setup is very promising, and the cost should be lower,” said Wenjun Zhou, a postdoctoral researcher working with Vivek Srinivasan, associate professor at the UC Davis Department of Biomedical Engineering.
If you shine a light into a cloudy solution, light particles, or photons, will be scattered in different directions. An experimental technique called diffuse correlation spectroscopy, or DCS, uses essentially this approach to look inside someone’s skull. Laser light is shined on the head; as photons from the laser pass through the skull and brain, they are scattered by blood and tissue. A detector placed elsewhere on the head, where the photons make their way out again, picks up the light fluctuations due to blood motion. These fluctuations provide information about blood flow.
The light signal is very weak, and the further it passes through the skull and brain tissue, the weaker it gets. So DCS requires a number of very sensitive, expensive single photon counting detectors. Boosting the light going in risks burning the patient’s skin.
Zhou and Srinivasan took a different approach, based on the fact that overlapping light waves will reinforce or cancel each other out, like overlapping ripples on a pond.
They first split the light beam into “sample” and “reference” paths. The sample beam goes into the patient’s head and another, stronger, reference beam is routed so that it reconnects with the sample beam before going to the detector. This boosts the signal, meaning that instead of needing about 20 photon-counting detectors that cost a few thousand dollars each, the researchers could use a single CMOS-based digital camera chip for a fraction of the price.
“The strong reference light enhances the weaker signal from the sample,” Zhou said.
They call the method interferometric diffusing wave spectroscopy, or iDWS. An added advantage is that they do not need to turn off the room lights while making measurements with iDWS, Zhou said. Eventually, they may even be able to monitor brain blood flow outdoors, under bright sunlight.
So far, the team has tested their device by making brain recordings from volunteers in the laboratory. They are working with Dr. Bruce Lyeth and Dr. Lara Zimmermann in the UC Davis Department of Neurological Surgery to validate and adapt the technology for eventual use in neurocritical care. UC Davis has applied for a provisional patent on the technology.
Other authors on the paper are graduate student Oybek Kholiqov and postdoctoral researcher Shau Poh Chong. Srinivasan also holds an appointment at the Department of Ophthalmology and Vision Science, UC Davis School of Medicine. The work was funded by grants from the National Institutes of Health.

University of California – Daviswww.ucdavis.edu/news/new-technology-measuring-brain-blood-flow-light

Siemens Healthineers and ScreenPoint Medical have agreed to partner to develop artificial intelligence-based applications for breast imaging. This collaborative arrangement also includes the acquisition of a strategic minority stake in ScreenPoint Medical by Siemens Healthineers.
The partnership intends to leverage the superior expertise of Siemens Healthineers in breast imaging as well as that of ScreenPoint Medical in mammography decision support to develop innovative clinical applications for breast cancer screening and diagnosis. Professor Nico Karssemeijer, CEO of ScreenPoint Medical, explains, “together with Siemens Healthineers, we can bring our expertise in AI into the entire screening and diagnostic pathway, starting from risk stratification to image acquisition and diagnosis.”
“The aim of our collaboration with ScreenPoint Medical is to expand precision medicine by providing automated clinical decision support that makes it easier and faster to distinguish between healthy and tumour tissue, thus increasing diagnostic accuracy,” adds Dr. Pete Schardt, head of X-ray Products at Siemens Healthineers. “Working with strong partners such as ScreenPoint will help us drive personalized breast care pathways with new applications based on deep learning and artificial intelligence.”
Both companies pool their individual strengths in their strategic partnership. ScreenPoint Medical’s current, highly innovative mammography reading software, Transpara, is available for a variety of mammography systems. It enables clinical decision support and computer-aided detection for higher reading accuracy. It has been proven to help radiologists better detect breast cancer with mammography and reduce variations between different users – both aspects integral in expanding precision medicine. Transpara is cleared for clinical use for CE-countries with the digital mammography and reading portfolio of Siemens Healthineers. In the coming months, ScreenPoint plans to attain regulatory approvals for the Transpara solution in further clinical applications and countries.
Siemens Healthineers has a long-standing history of innovations in breast imaging and a comprehensive portfolio of systems across ultrasound, mammography and MRI as well as the accompanying reading solutions. The latest addition in mammography, Mammomat Revelation, offers the highest depth resolution on the market with a unique 50-degree wide angle for tomosynthesis. Automated and precise breast density measurements allow for instant risk stratification. On the reading side, Syngo.BreastCare offers advanced visualization for 2D and 3D mammography with automatic workflows and Artificial Intelligence (AI)-based tomosynthesis reading.
www.siemens-healthineers.comwww.screenpoint-medical.com

The evidence is clear: Cervical cancer is best treated with brachytherapy, a form of radiation therapy. Yet the use of this potentially lifesaving treatment has been declining, and a new study from the University of Virginia School of Medicine may explain why.
UVA researchers have determined that offering brachytherapy for locally advanced cervical cancer ends up costing hospitals money. After accounting for the costs and time involved, the researchers found that Medicare reimburses four times more per minute required for a less effective alternative than it does for brachytherapy. Ultimately, providing brachytherapy results in a net loss for the providing healthcare facility, the researchers determined. This can leave hospitals – particularly smaller hospitals that don’t do a lot of brachytherapy – in the lurch.
“Studies have time and time again shown that brachytherapy is the most important part of cervical cancer treatment, because it is essential to eradicating the tumour,” said Timothy Showalter, MD, a radiation oncologist at UVA Cancer Center. “A decline in brachytherapy utilization is associated with a higher rate of mortality in cervical cancer, so there’s a direct relationship.”
The problem stems partly from the amount of physician time brachytherapy requires: It takes 80+ percent more personnel time to administer brachytherapy than it does to deliver the increasingly popular alternative, external beam radiation. Both methods deliver radiation to the tumour, but brachytherapy delivers much greater doses in a much more targeted manner. Another key difference, the researchers found: Medicare reimbursement makes external beam radiation profitable, while brachytherapy is not.
Overall, the researchers determined that it costs hospitals more than twice as much to provide brachytherapy as it does to provide external-beam radiation. But the reimbursement doesn’t reflect that.
“Brachytherapy requires a lot of physician effort and expertise and reimburses poorly for that effort,” Showalter said. “I can certainly imagine how the comparatively poor reimbursement rates compared to external beam radiation could contribute in some environments to not establishing a service for brachytherapy or just not committing physician time to it.”
He noted that healthcare providers face a cold, hard truth when deciding whether to offer brachytherapy, or any other treatment: “If practices don’t run at least a profit greater than zero,” he said, “then they fold.”
The researchers concluded that hospitals that see a high volume of patients, such as UVA, are best equipped to provide brachytherapy – and to absorb the major resource commitment that comes with it. “My job specifically involves brachytherapy,” Showalter said. “We’re at this big hospital with all the equipment we need at the ready and a wonderful streamlined process that enhances the patient experience and reduces patients’ time on the table. That makes it easier to provide efficient and effective care.”
EurekAlerthttps://tinyurl.com/y9oqfbe4

Carestream Health will demonstrate advanced artificial intelligence and imaging analytics software tools that are designed to enhance both the quality and speed of diagnosis and reporting for radiology imaging exams at the HIMSS 2018 tradeshow.

Carestream currently incorporates third-party algorithmic results for osteoporosis, lung emphysema, coronary calcification and fatty liver as part of its Clinical Collaboration Platform.

“With the many challenges facing medical imaging at hospitals of all sizes, achieving a balance between quality and cost is essential. By using an algorithm-enabled Radiology Assistant, users can boost diagnostic confidence while simultaneously improving productivity and containing costs,” said Thierry Verstraete, Carestream’s Global Product Manager Clinical Solutions & Analytics.

The Radiology Assistant, using the Coronary Calcium Scoring (CCS) algorithm (Not available in the United States pending 510(k) Clearance), provides detailed findings with key diagnostic images that are available to radiologists a few minutes after image acquisition. 

“Artificial intelligence can calculate and provide incidental findings, critical findings or quantitative assessments to help streamline radiologists’ reading workflow and allow early treatment that can reduce the impact of a disease or condition. Early treatment also may

reduce the increased financial burden for patients, governments and healthcare providers that will come with these complications,” Mr. Verstraete explains.

As part of its Clinical Collaboration Platform, Carestream’s Workflow Orchestrator directs the study to the best radiologist for each case based on subspecialty, location and affiliation.

The Workflow Orchestrator fabric contains a vast array of sensors that generate data on a continuous basis. Carestream recognizes the need for self-improving systems where algorithms can continuously process these same insights and propose various system configuration adjustments with improved predictions for quality and productivity.

 “Our goal is to offer the tools radiologists need to make an accurate diagnosis while also delivering a radiology report that accurately communicates diagnostic information to physicians,” said Mr. Verstraete. “A diagnostic report can only be considered great if the referring physician thinks it is.”

The heart is capable of terminating arrhythmias itself after local gene therapy, potentially avoiding the need for patients to undergo painful electric shocks, according to a proof-of-concept study.
Atrial fibrillation is the most common heart rhythm disorder (arrhythmia). Treatment aims to restore the heart’s normal rhythm and includes drugs, which are not effective in all patients, ablation, for which efficiency remains suboptimal in the long-term, and electric shocks, which are effective but painful and require hospitalization. This leaves a large and growing group of patients without optimal treatment options.
That is why study author Dr Emile Nyns, a physician and PhD candidate in the laboratory of Daniël Pijnappels at the Leiden University Medical Centre, Leiden, the Netherlands, took a completely different approach. He said: “As the heart itself is already electrically active, we tested whether and how it could generate the electrical current needed for arrhythmia termination.”
The researchers used a technique called optogenetics, which uses light to control functioning of cells that have been genetically modified to express light-sensitive ion channels.
First they genetically modified the right atrium in eight adult rats using a process called gene painting, which involves a small thoracic incision and actually painting the atrium with vectors coding for these ion channels.
The researchers waited four to six weeks for the light-sensitive ion channels to be expressed, then made a small incision in the thorax of each rat and induced atrial fibrillation. Next they shone a light on the atrium for one second. This terminated 94% of atrial fibrillation.
Dr Nyns said: “Shining light on the atrium opened the light-sensitive ion channels. This led to depolarization of the atrium, which terminated atrial fibrillation and restored the heart’s normal rhythm. We only needed a single light pulse of one second to terminate nearly all arrhythmias.
“The heart itself generated the electrical current needed to stop the arrhythmias,” he continued. “It is completely pain free, unlike electric shocks.”
He said: “Our study provides proof-of-concept that the heart can be enabled to terminate atrial fibrillation by itself after optogenetic gene therapy.”
In future Dr Nyns envisages that the technique could be used in atrial fibrillation patients together with an implantable light-emitting diode (LED) device. “The result would be continuous, ambulatory and pain-free maintenance of the heart’s normal rhythm, something that cannot be achieved today,” he said. “The quality of life and prognosis of AF patients could be significantly increased, especially for patients with frequent episodes of drug refractory, symptomatic atrial fibrillation, despite ablation therapy.”
The researchers did not observe adverse effects from the method, but Dr Nyns said: “Further research is certainly needed before this technique can be used in patients. However, the results are promising and we believe that the time has come to develop the next generation of therapy for cardiac arrhythmias, which do not rely on pills or electronics, but on biology instead.”

ScienceDailyhttps://tinyurl.com/yc4atkg8