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Making therapeutic procedures more pre- cise, efficient and effective was the purpose behind the development of two other combi- nation systems — the Angio CT Miyabi, a CT device combined with an angiographic sys- tem (used for imaging blood vessels), and the Primatom, which combines a CT system with a linear accelerator (used to treat tumors).
moveable C-arm. The purpose of the proce- dure is to detect vascular defects, such as nar- rowing or dilatation. The resulting image in- formation aids physicians in precisely steering catheter during cardiac catheterizations (p. 70). But angiography does not clearly delin- eate surrounding tissues. That information is provided by CT. Here too, software enables
The biograph 64 combines the latest PET technology with a 64-slice CT system. The image on the right reveals that the inner portion of a lung tumor (shown here to the left of the spine) is inactive, because the radioactive tracer has failed to accumulate there (Baptist Hospital, Hong Kong).
A new ultrasound system from Siemens can create three-dimensional motion pictures in real time — ideal for determining whether fetal movement is normal.
Unlike Symbia and biograph, these devices are not assembled in the same housing. Instead, the CT system is supported on rails, and can be moved into the angio lab or the radiation therapy room. Nevertheless, the patient does not have to be moved, and both procedures can be performed in quick succession.
The Miyabi system was developed espe- cially for treating patients suffering from vas- cular disease. Here, an X-ray source and an image receptor are juxtaposed on a freely
the two data sets to be precisely superim- posed, which is particularly useful in evaluat- ing and treating strokes. To minimize brain damage, for instance, it’s essential to decide quickly whether the problem is a cerebral hemorrhage or a clotted artery, because these two conditions require entirely different treatments. In the past, the patient had to be rapidly transferred from one machine to the other. However, with the Miyabi system this will become unnecessary in many cases.
The Primatom has many advantages in imaging-controlled radiation therapy. Tu- mors in the back, pelvis or abdomen can shift in position from day to day due to organ movements or to volume changes in the di- gestive tract. The Primatom system gener- ates a highly energetic radiation beam used to destroy tumors, and it also creates a de- tailed CT image of the same body region. This combination substantially facilitates pa- tient positioning for accurate targeting of the treatment beam.
Ultrasound in 4D. Another area in which software is vital in improving conventional procedures is ultrasound. “Many experts used to think that this technology could not be fur- ther improved,” says Gerhard Kreitz, market- ing manager at Med in Erlangen. “But with the Acuson Antares Premium we’ve brought a device to the market that shows that much more can be done.”
The Acuson Antares uses fourSight 4D technology to create images in four dimen- sions: It depicts the area of interest not only in 3D but also in motion. “That’s especially im- portant in examining fetuses, because their movements provide clues about their neuro- logical development.” The system also makes it easier to recognize malformations, such as anomalies of the face or fingers. As a result, the Acuson Antares is used mostly for gyne- cological studies, and in 90 percent of those for prenatal exams.
The Acuson Antares’ innovative transducer doesn’t need to be moved across the patient’s abdomen but remains stationary. Inside it, a small motor causes the sound probe to oscil- late in precisely defined trajectories. The ad- vantage? The device always knows the exact position of the sound waves. “We know ex- actly where each pixel is located,” explains Kreitz.
Acuson Antares scans the volume of inter- est up to 25 times per second and generates tomograms of different tissue layers, which the software combines into a 3D stack — so fast that movements can be displayed in real time. “To do this, the image composition must be extremely precise, and the software must handle a gigantic data volume — up to two gigabytes,” notes Kreitz. But the most im- portant issue is what the system can do with the data. That’s why Antares has been equipped with additional functions. The physician can view the volume as a whole, scroll though the sections, select any desired layer, and of course observe the movements of the fetus at normal speed. ■ Tim Schröder
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Facts and Forecasts
IT: Prescription for Health T says Saha. Today the focus is on IT for medical applications. “It accounts for about 60 per- cent of all IT expenditures, and in five years that figure will be 80 percent,” Saha adds. he market for information technology in hospitals grew from 2.4 billion euros to just under 3.5 billion euros in Europe alone between 2000 and 2004, according to a study conducted by Frost & Sullivan (F&S). “On average, European hospitals spend around 2 percent of their total annual budget on IT,” says Siddharth Saha, Manager for Healthcare IT and Medical Imaging at F&S. “Depending on the size of the clinic, this Software in Hospitals. According to Saha, physicians’ wish lists begin with digital technology that improves the quality of care, such as electronic patient files or Computer- ized Physician Order Entry systems. CPOEs
agement systems and medical equipment. Saha expects that this emphasis will continue over the next three to four years. After that, however, he believes that there will be in- creased demand for PACS systems in China as well. In India, private clinics are playing a pio- neering role in the development of clinical IT systems. “Over the past two to three years, In- dian hospitals have primarily bought adminis- tration and accounting systems,” says Saha. In the next phase, they will be introducing electronic prescriptions, followed by PACS sys- tems. “At the moment, there are only a hand- ful of such systems in India,” says Saha.
Automatic Image Evaluation. According to Saha, automatic image evaluation systems
IMAGE EVALUATION: A GROWTH MARKET
European market for CAD (computer-aided detection) systems
Sales in millions of U.S. dollars
20 10 0
2002 2003 2004 2005 2006 2007 2008
Source: Frost & Sullivan (2004). Base year: 2003
INFORMATION SYSTEMS: GROWING DEMAND
European market for clinical information systems
Sales in millions of U.S. dollars 7000
Growth rate 14%
2002 2003 2004 2005 2006 2007 2008 2009 2010
IT PRIORITIES: WHAT HOSPITAL CEOS & CFOS WANT MOST
Inpatient clinical information systems Diagnostic imaging storage, retrieval and transfer across a health network Clinical communications and links to physicians Ambulatory clinical information systems Consolidation of all information system functions Financial applications (e.g., patient and general accounting) Physician office/practice management Data warehouses Telecommunications, network management Telemedicine Receiving software via application service provider approach Home healthcare systems Enabling patient access to selected data via the Internet
Survey of 394 CEOs and CFOs of U.S. hospitals
20% 20% 19% 16% 15% 15%
Percentage of respondents
30 40 50 60 70
amount ranges between 20,000 euros and 2 million euros annually.” In the U.S. as well, hospitals spend about two percent of their to- tal budget on IT, according to a study pub- lished by PricewaterhouseCoopers in April 2005. “In the past, around 80 percent of all IT budgets were spent on administration and ac- counting systems. Today that figure is only 40 percent, because in most hospitals adminis- trative activities have been largely digitized,”
enable doctors to enter and transmit elec- tronic prescriptions and order lab tests through their computers. In the U.S., inpatient clinic information systems and programs for man- aging diagnostic images (PACS, Picture Archiving and Communication System) have top priority.
Strong Growth in Asia. In recent years, China has made major investments in man-
Source: PricewaterhouseCoopers (2005)
(computer-aided detection, CAD) are the next logical step hospitals will take after investing in PACS systems. CAD systems analyze not only digitized X-rays and mammograms but also data from computer and magnetic resonance tomographs, automatically identi- fying pathological changes in tissue, such as tumors.
Clinics in Europe have already installed 270 of these systems, 90 percent of them in mammography. According to Frost & Sullivan, these systems have increased the detection rate for breast cancer by 25 percent. They are also being increasingly used for the detection of lung and intestinal cancer (see p. 67). Be- cause CAD systems, which cost around $150,000, are two to three times as expen- sive as PACS systems, they are generally pur- chased only by large hospitals.
Frost & Sullivan estimates that the CAD market in Europe, which had a volume of $27 million in 2003, will grow by an average of 26.5% annually until 2008. According to forecasts, it will reach a level of approxi- m a t e l y $ 8 7 . 5 m i l l i o n a t t h a t p o i n t . ■ M i c h a e l L a n g
Pictures of the Future | Fall 2005
Source: Frost & Sullivan (2004)