August 2012

Anatomy of Curing Disease

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The modern day medical science owes much to the founder of CT scan inventor (Sir Godfrey Hounsfield) as the device has advanced the diagnostic process to much extent.

By Sharmila Das, Elets News Network (ENN)

Computed Tomography Scanner or CT Scans are far more detailed than ordinary X-rays. The information from the two-dimensional computer images can be reconstructed to produce three-dimensional images by some modern CT scanners. They can be used to produce virtual images that show what a surgeon would see during an operation thus making the treatment much easier and accurate.

The Role
Dr. TBS Buxi,Hony. Consultant, Head CT Scan and MRI at Sir Ganga Ram Hospital says, “CT has an all important role in diagnosing patients with diverse diseases ranging from sub-clinical infections to disseminated cancers. All organs and organ systems can be evaluated for anatomical or morbid changes whether congenital from birth or acquired. The diagnostic range is from the routine scans to advanced whole body angiograms, virtual endoscopies and virtual bronchoscopies, with 3D and multiplanar reconstructions aiding in planning therapy and surgery. Organ transplants, interventions diagnostic or therapeutic, are possible on CT”.
Dr H Satishchandra, FICR. Prof & Head, Dept. of Radiodiagnosis & Imaging, Bangalore Medical College & Research Institutite, says, “Cross sectional imaging and reconstruction with a CT scanner is one of the best and fastest methods to image patients with acute or chronic diseases and in trauma. CT scanner can image practically any part of the body, helping the clinician in making a quick and confident diagnosis and plan further management.”

Dr. Sunita  Dube, Consulting Radiologist, Sonologist & Director, Aryan Hospitals says, “CT scan has many advantages over traditional 2D medical radiology. It is less time consuming very rapid acquisition of images, wealth of clear and specific information, and a view of large portion of body. It helps in demining when surgeries are necessary, reducing time of explorative surgery, improving cancer diagnosing and treatment, guiding treatment of common conditions like injuries, cardiac disease and stroke and also helps in improving patient placement in appropriate area of interest”.

Dr. Priya Chudgar, Senior Consultant Radiologist, Kohinoor Hospital says, “CT scan or computed tomography has revolutionised era of diagnostic imaging. Multi-detector-row computed tomography (MDCT) is the latest breakthrough in CT technology. It has transformed CT from a trans-axial cross-sectional technique into a truly three-dimensional imaging modality. This produces faster and better scans with shorter breath hold and less amount of iodinated contrast. It proves as blessing for morbid patients with poor renal function who require repeated scans. Newer machines also produce lesser radiation hazards”.

Cost of Installation
CT scans have already allowed doctors to inspect the inside of the body without having to operate or perform unpleasant examinations. CT scanning has also proven invaluable in pinpointing tumours and planning treatment with radiotherapy.
Dr Satish Chandra says, “The cost depends on the channel, software and the manufacturer. CT scanner price can range from ` 3 to 4 crore. Moreover, CT scan room with its console, air conditioners, electrical circuits to power the equipment, and radio absorbent materials for the walls will further add to cost.”

The Upkeep
CT equipment requires proper environment to keep the performance of the machine intact. For example it needs to be kept in an air conditioned place with constant power back up.
Dr. Chudgar says, “Ideally most CT scanners would require comprehensive maintenance contract. Depending on usage, X ray tube, detectors and other wear and tear may cost significant amount and hence regular contract with company serves as ideal deal. Any CT scan machine with average usage would require to be replaced or upgraded by 5-6 years”.

Standalone Diagnostic Center/Hospitals
Experts say due to growing aging population and widening usages of diagnostic imaging, the global imaging market is on the rise.  The Web says global diagnostic imaging market is expected to grow from USD 20.7 billion in 2010 to USD 26.6 billion by 2016, at a CAGR of 4.2 percent from 2011 to 2016.  Continuous developments in the imaging industry are primarily driving the diagnostic imaging market. Due to these supportive factors India is seeing an increase in the number of imaging centers/clinics. With such environment, the questions crops up that what are the necessary elements for a standalone diagnostic center-to this Dr. Buxi says, “The Atomic Energy Regulatory Board (AERB) regulations, for setting up diagnostic equipment at stand-alone centres and hospitals, need to be followed as far as the space needed, radiation protection of patients, medical staff and measures to avoid scatter radiation causing environmental biohazards. The Diagnostic centres need to be compulsorily evaluated by the certifying agencies for uniform quality care”.

Innovations Taking Place
New developments in the CT space is happening at a fast pace and the following make a noticeable impact.
Low Dose CT Technology Scanner: This is a scanner that can do what’s known as iterative reconstruction and dual-energy scanning, and it can do those while reducing radiation exposure to patients and still delivering high-definition images.
The Dual Source CT scanners: With the dual source CT scanner only 10 seconds is required to obtain detailed and accurate images. In 10 seconds, an image can identify life-threatening blockages, blood clots, blockages and other heart problems.
Dr. Buxi says, “The most important innovations have been the Low Dose CT technology scanners .TheDual Source CT scanners provide excellent image quality at lightning speed”.

Roadblocks
While it’s certainly true that CT has become an indispensible tool of today’s healthcare, there are some issues associated with the diagnostic machine as well. Some say that the radiation that comes out of the CT is hazardous for pregnant women and children.
Dr Chudgar says, “It is quite true that CT scan machine to be considered as white elephant, requiring regular maintenance and updates available in market. It is still profit making and essential component of any health care centre”.
Besides high prices of the equipment, easy availability is also a concern. Sometimes understanding the handling techniques also creates hazards. However, the benefits outweigh the disadvantages associated with CT.//

Doctors Say All organs and organ systems can be evaluated for anatomical or morbid changes whether congenital from birth or acquired
Dr TBS Buxi, Hony. Consultant, Head CT Scan and MRI, Sir Ganga Ram HospitalDepending on usage, X ray tube, detectors and other wear and tear may cost significant amount and hence regular contract with company serves as ideal deal
Dr Priya Chudgar, Senior Consultant Radiologist, Kohinoor Hospital 
It helps in demining when surgeries are necessary, reducing time of explorative surgery, improving cancer diagnosing and treatment
Dr Sunita  Dube, Consulting Radiologist, Sonologist & Director, Aryan Hospitals

CT scanner can image practically any part of the body, helping the clinician in making a quick and confident diagnosis and plan further management- Dr H Satishchandra, Jaslok Hospital & Research Centre

 


The Upkeep
CT equipment requires proper environment to keep the performance of the machine intact. For example it needs to be  kept in an air conditioned place with constant power back up.
Dr. Chudgar says, “Ideally most CT scanners would require  comprehensive maintenance contract. Depending on usage, X ray tube, detectors and other wear  and tear may cost significant amount and hence regular contract with company serves as ideal deal. Any CT scan machine with average  sage would require to be replaced or upgraded by 5-6 years”.

Standalone Diagnostic Center/Hospitals
Experts say due to growing aging population and widening usages of diagnostic imaging, the global imaging market is on the rise. The Web says global diagnostic imaging market is expected to grow from USD 20.7 billion in 2010 to USD 26.6 billion by 2016, at a CAGR of 4.2 percent from 2011 to 2016. Continuous developments in the imaging industry are primarily driving the diagnostic imaging market. Due to these supportive factors India is seeing an increase in the number of imaging centers/clinics. With such environment, the questions crops up that what are the necessary elements for a standalone diagnostic center-to this Dr. Buxi says, “The Atomic Energy Regulatory Board (AERB) regulations, for setting up diagnostic equipment at stand-alone centres and hospitals, need to be followed as far as the space needed, radiation protection of patients, medical staff and measures to avoid scatter radiation causing environmental biohazards. The Diagnostic centres need to be compulsorily evaluated by the certifying agencies for uniform quality care”.

Innovations Taking Place
New developments in the CT space is happening at a fast pace and the following make a noticeable impact.
Low Dose CT Technology Scanner:
This is a scanner that can do what’s known as iterative reconstruction and dual-energy scanning, and it can do those while reducing radiation exposure to patients and still delivering high-definition images.
The Dual Source CT scanners:
With the dual source CT scanner only 10 seconds is required to obtain detailed and accurate images. In 10 seconds, an image can identify life-threatening blockages, blood clots, blockages and other heart problems.
Dr. Buxi says, “The most important innovations have been the Low Dose CT technology scanners .TheDual Source CT scanners provide excellent image quality at lightning speed”.

Roadblocks
While it’s certainly true that CT has become an indispensible tool of today’s healthcare, there are some issues associated
with the diagnostic machine as well. Some say that the radiation that comes out of the CT is hazardous for pregnant women and children.
Dr Chudgar says, “It is quite true that CT scan machine to be considered as white elephant, requiring regular maintenance and updates available in market. It is still profit making and essential component of any health care centre”.
Besides high prices of the equipment, easy availability is also a concern. Sometimes understanding the handling techniques also creates hazards. However, the benefits outweigh the disadvantages associated with CT.

 


Enabling Imaging Accuracy

Atul Kulkarni, Business Manager-CT, Philips Healthcare delves into CT and brings out the intricate details of the imaging machine.

Share with us any innovation which has taken place in the CT scan market over last five years.
With advancement in multi-detector technology, CT is becoming faster and giving finer details of the anatomy. It is helping patient management in many ways. Now, one can image whole body within five seconds with slice thickness less than a millimeter. This helps in detecting a disease at very early stage and changing the course of patient management, ifrequired. It is also much earlier for patient who has to hold his breath for very short time.
Iterative reconstruction techniques have evolved over last couple of years and are becoming standard for all routine application on CT imaging. With Philips iDOSE4 iterative reconstruction technique it is possible to reduce dose up to 80 percent without affecting the quality of imaging and hence diagnosis. Philips has developed iDOSE4 to make it useful for all clinical condition routinely and it is also available for older generation scanners. The focus is also to make technology affordable for all with increasing productivity and efficiency at all levels.
What is your market share in the industry?
Philips is a leading player in the industry and enjoys a majority share of premium segment in CT market, which is growing year-on-year.

Please brief us about the challenges/opportunities we see in the market where the technology changes every six months.
Though advancements and changes are expected in any technology-driven industry but it is not as fast as six months. However, at whatever pace it happens, the care-providers have to invest regularly in up-gradation to match pace with the market. On the other hand they also have to look at return on investment when they are spending on upgrade. The benefit of up-gradation come in form of access to latest or most recent technology and getting clinical and competitive advantages.

Do CT scanners require maintenance? If so, what is the stipulated time for such equipment to be replaced and upgraded?
CT scanner needs preventive maintenance as it involves lots of continuously moving parts. These parts are subjected to wear tear. CT scanner needs regular maintenance and calibrations. The stipulated time period for preventive maintenance is about 3-6 months depending on the system.
The CT scanner can work for several years if maintained properly but technological obsolesce is about 7-10 years. Philips has programs where one can upgrade the system in terms of hardware and software capabilities. We also offer exchange program for user to encourage them to upgrade to newer technology.

 


Revolutionary PET Imaging

Sudhir KN, Business Head – Molecular Imaging, Siemens Healthcare, feels just as high definition TV has redefined the television viewing experience, High Definition PET (HD.PET) has forever changed the way physician sees PET.CT images.

PET.CT as a diagnostic tool represents a quantum leap in the quality of healthcare delivered. The introduction of HD.PET has further raised the bar and revolutionised PET.CT imaging.
HD.PET offers 2 mm uniform resolution across the field of view. It enables razor sharp, distortion free image quality from edge to edge, allowing the physician to precisely visualise even the tiniest lesions with unmatched contrast and clarity.
This clinical benefit of HD.PET has forever changed the way PET images were viewed by physicians across the world.
Implementation of this technology has impressed physicians in India by helping them resolve even the most critical cases.
Conventional Vs HD.PET Conventional PET scanners use the same reconstruction principles across the entire field of view (FOV) and do not take into account detector geometry and mispositioning of the line of response (LOR). This results in fuzzy edges and increased distortion further from the center of FOV.
The photon further away from the center of the FOV, the less likely the LOR will be calculated correctly, because the photon will hit the crystal at an angle and continue traveling to another crystal before it lights up. HD.PET incorporates millions of accurately measured Point Spread Functions (PSFs) in the reconstruction algorithms. A PSF describes the response of an imaging system to a point source or point object. A system that knows the response of a point source from everywhere in its FOV can use this information to recover the original shape and form of imaged objects. PSFs are also used in precision imaging instruments, such as microscopy, ophthalmology and astronomy (e.g. the Hubble telescope) to make geometric corrections to the final image.
Using measured PSFs, HD.PET effectively positions the LORs in their actual geometric locations, which dramatically reduces blurring and distortion in the final image.

Clinical Benefits of HD.PET
HD•PET has made a remarkable improvement in viewing of clinical PET.CT images. It delivers uniform sharpness with virtually no distortion — even at the edge of the FOV and more consistent visualisation of fine details.
With uniform spatial resolution of 2mm throughout the entire FOV, HD•PET provides the highest level of detail to improve detection of tiny lesions, even in places that were difficult to visualise earlier, such as the lymph nodes, abdomen, mediastinum, head, neck and cerebellum. With a 2x improvement in signal-tonoise ratio, HD•PET provides sharper image contrast and greater distinctness, thereby helping in ease of reading the images. The physician gets the highest levels of PET contrast ever delivered. The key features of HD.PET i.e. HD uniformity, HD resolution and HD contrast culminate in superior level of image clarity than other PET technology.

Latest Innovation
The new Biograph mCT brings accurate and reproducible quantification to PET•CT imaging, by ensuring that each element of the measurement chain is optimised. Starting with the industry’s highest volumetric image resolution, Biograph mCT features unique daily quality control, SMART registration technologies and intelligent software, to bring accuracy and reproducibility to PET•CT imaging. In addition, innovative Combined Applications to Reduce Exposure (CARE) technologies ensure the lowest possible dose is administered.Physicians can detect, characterise and monitor the tiniest cancer lesions with reproducible quantification, making cancer treatment more cost effective. More than ever, one can rely on molecular imaging with quantification that is accurate and reproducible. For results that will redefine clinical decision making and the confirmation one would need for more diagnostic certainty and more informed treatment planning.

Market and Future
The PET.CT modality is critical as the search for balance between innovation and healthcare access continues. The likelihood that universal adoption of PET.CT technology will increase with accessibility is a shared industry vision. At the same time, HD.PET has been tried and tested at various luminary clinical sites around the world and is getting widely accepted. Even in India, customers have found HD.PET extremely useful.
Currently, till date ten PET.CT scanners have been installed in India with this high end HD.PET option and four more will be installed shortly. The same trend is seen world over with more customers moving towards HD.PET technology. This current trend globally indicates that more and more customers prefer accurate diagnostic technology like HD.PET.

 

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