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Featured Articles
Is the hospital becoming a real business ? Move to new value-based models inevitable
Escalating costs make new business model unavoidable
There is still no consensus about where hospitals should be positioned in the healthcare service spectrum of the future. However, it is widely accepted that relying wholly on growth in patient numbers, bed-days and on more expensive equipment, procedures and physicians has become untenable.
Some hospitals are enthusiastically embracing change. Many more remain cautious. Few however doubt that spiralling healthcare costs will force hospitals to be funded and operated via new business models, more akin to that of other economic sectors.
All things to all people, all the time
Innosight, a healthcare consultancy founded by Harvard Business School Professor Clay Christensen, puts the problem in perspective. In marked contrast to general hospitals, few organizations
Pattern recognition: unlocking the secrets of data
Pattern recognition consists of labelling data inputs and interpreting them according to a broad range of criteria, from classification and sequencing to regression and parsing. At the most fundamental level, pattern recognition may be a basic definition of
A healthy dose of radiation monitoring
With the drive for dose reduction and improved dose registration gathering pace, Dr. Jamie Fraser, Dorrell Metcalfe and Susan Delaney of the Queen Elizabeth II Hospital in Halifax, Nova Scotia, explain how they worked with Agfa HealthCare on the development of the IMPAX REM.
As the largest teaching hospital and adult academic health sciences centre in Atlantic Canada, Capital District Health Authority, with its reputation as a centre of excellence in health research, was an obvious choice as a pilot site for Agfa HealthCare
Digital tomosynthesis – the promise of 3D mammograms
Digital tomosynthesis is a new, three-dimensional (3D) technology which promises to address key shortcomings of conventional mammography. It also offers a way to tackle some of the challenges faced by computed tomography (CT) and is under investigation for a variety of new medical and surgical applications.
The concept of digital tomosynthesis is clean and elegant. A 3D slice is made by superimposing (and retrospectively reconstructing) consecutive high-resolution images, taken from different angles, across an arc. The accompanying 2D images are also used for interpretation by radiologists.
Flat-panel technology, CT pave the way
Tomosynthesis was already known in the 1930s, as part of the family of geometric tomography techniques. However, the use of plain film meant that it was procedurally painstaking, since only one image could be acquired at a time. Even more problematic was the high dosage of radiation required to produce more imaging sections.
The emergence of computed tomography (CT) in the 1970s generated a new wave of excitement about tomosynthesis. However, progress remained dormant until the mid-1990s, when the advent of flat-panel digital detectors promised a means for tomosynthesis to acquire both technical traction and momentum.
One of the most important characteristics of flat-panel technology is the lack of distortion, since its geometry (rows and columns) is known. As a result, it is possible to interpolate reconstructions on the exact point in a tomographic layer, from which data has been recorded.
First-generation flat-panel tomosynthesis systems were, nevertheless, handicapped by speed. Experimental devices, even in the late 1990s, could only achieve four to five frames per second (FPS). However, flat panel technology has evolved since then, fuelled by increasingly sophisticated optoelectronics and back-end algorithms to interpret the data. As a result, it is now possible to acquire images at 20-30 FPS with a radiation exposure similar to a chest X-Ray.
Different from CT
In spite of parallels, digital tomosynthesis and CT are two different techniques. Unlike the former, which typically consists of 15 images across a 15 degree arc, CT makes a full 360-degree rotation around a patient to acquire data for image reconstruction.
In digital tomosynthesis, the fewer data sets entail limited depth of field, and an inability to attain the very narrow slice widths of CT. However, given the digital processing of an image, one data set can provide for reconstruction of slices with both different depths and thicknesses; this not only saves time but radiation exposure requirements too.
Addressing limitations in slice width, but cost remains concern
Considerable efforts are underway to address the limits to slice width in digital tomosynthesis, especially in the form of more sophisticated detectors which allow higher in-plane resolution. The algorithms used to reconstruct tomosynthesis data are also more complex than CT. Together, both add to cost.
The Year of 3D Mammography
The application where digital tomosynthesis has drawn maximum attention is mammography. Indeed, digital tomosynthesis is now widely labelled as
Ultrasound outreach – expanding frontiers
From formal outreach programmes in obstetrics and gynecology, ultrasound has begun extending to new frontiers. The most prominent of these include emergency medicine and mass casualty incidents (natural disasters, terror attacks and large-scale accidents). However, the effectiveness of ultrasound outreach has also been demonstrated in cardiac care, and may provide an answer in the future to glaucoma, the second leading cause of blindness in the world.
Roots in ob-gyn
One of the earliest and best known proponents of ultrasound outreach is the London-based International Society of Ultrasound in Obstetrics and Gynecology (ISUOG). ISUOG
Hybrid imaging – of structure and function
Hybrid imaging is the fusion of medical images, most commonly from CT (computed tomography), PET (positron emission tomography) and MRI (magnetic resonance imaging), in order to enhance visualisation. It addresses both anatomical detail and functional processes, thereby providing superior accuracy for diagnosis and the monitoring of interventional procedures. In several cases, it is also accompanied by lower radiation exposure for patients.
Hybrid imaging is now being used to combine structural and molecular imaging – revealing molecular processes in vivo while depicting their anatomic location. Some proponents believe the technique marks the dawn of the era of personal medicine.
Medical Invention of the Year
The age of hybrid imaging could be considered to have begun in the year 2000, after PET/CT was heralded as the