- Email: [email protected]
Clinical and Research Updates
CLINICAL AND RESEARCH UPDATES Compiled by Jonathan W.K. Lee, Ph.D., Lead Instructor, MRI/S Technologist Program, Red River College & Affiliated Scientist, Institute for Biodiagnostics, National Research Council, Winnipeg, MB 128-channel MRI Collaboration GE Healthcare (Waukesha, WI) and the Mayo Clinic (Rochester, MN) have announced a program for the clinical development of high-field MRI of the body, and Massachusetts General Hospital (MGH of Boston) and Siemens Medical Solutions (Malvern, PA) have developed a prototype 128-channel MRI system based on Tim (Total imaging matrix) technology. The GE Healthcare collaboration is designed to help realize the full potential of 3T MR systems as a diagnostic tool, particularly for the abdomen, heart, breast, and musculoskeletal system. Along with the Mayo Clinic's Body MRI Advanced Development Unit, GE Healthcare will develop and apply clinically viable techniques and protocols for 3T, allowing Mayo's patients to benefit from the potential to accurately diagnose such conditions as breast and prostate cancer, liver disease, and coronary artery disease.1 The Siemens Medical collaboration involves research and development of the Magnetom Trio with Tim 3T MRI system. The prototype of the system is based on 102 coil elements integrated in 32 independent radiofrequency (RF) channels. The principles and potential applications of 128-channel MRI scanning are being evaluated at MGH, with initial findings showing the potential to exceed current standards of image resolution and parallel imaging, with up to a 25-fold increase in speed. The prototype is designed to be suitable for clinical and research imaging, especially in cardiology and advanced neurology, where speed and sensitivity are paramount.2
Interventional MRI Collaboration Biophan Technologies Inc (West Henrietta, NY) has announced a strategic research collaboration between Siemens Medical Solutions’ MRI Division (Erlangen, Germany) and Biophan Europe GmbH. The goal is to provide new solutions in interventional MRI and MRI-assisted minimally invasive surgeries. The collaboration is for the further development and commercialization of potentially complementary MRI technologies, including MR compatible pacemakers. Siemens Medical has developed a new MRI-scanning technology with aperture configurations, and Biophan is attempting to enable effective MRI visualization of implanted medical devices, including heart valves, coronary and peripheral stents, and vena cava filters.3
Strategic Partnership for Function MRI Neurognostics Inc (Milwaukee, WI) has signed a strategic partnership agreement with Medical Numerics Inc. (Sterling, VA)4 to enhance the company's offering of functional MRI (fMRI) tools and applications, which is based on Medical Numerics' proprietary fMRI tool set and Neurognostics' MindState fDPD fMRI application software. With fMRI, clinicians can measure brain function, enabling a real look at the way the brain works. The technology has a number of promising clinical applications, specifically in the areas of presurgical brain mapping for assessing neurological risk, early identification
of psychiatric and central nervous system disorders and measurement of the effects of therapies in neurodegenerative and neurodevelopmental disorders.5
Hardware-Independent MR The MR Technology Group of NRC-IBD (West) has been working on an integrated MR console and MR physics simulation system. The system consists of a research MR console with a full-function hardware-independent pulse programming environment, and a parallel computer cluster running full Bloch equation simulations on a 3D digitally-defined spin phantom. This allows side-by-side comparisons of experimental vs. simulated data for any pulse sequence. The simulator employs multiple spins per voxel, which allows the development of stochastic tissue models and the simultaneous simulation of multiple physical phenomena. The console sequencer software executes on a Pentium III running a real-time operating system (RTOS). A full pulse sequence library, including over 40 imaging, spectroscopy and utility sequences, has been implemented. The console has been successfully installed on a 9.4T/21cm animal MR imaging system in Edmonton.6 In addition, the University of Alberta Hospital, Stollery Children’s Hospital, the University of Alberta Research Center and the Mazankowski Heart Institute have two Siemens 1.5T clinical MRI, one 1.5T research MRI, soon to be installed a 1.5T Intra-operative MRI and a dedicated 1.5T Cardiac MRI.
Ceiling-mounted MRI Siemens Medical Solutions (Malvern, Pa) and IMRIS Inc. (Winnipeg, MB, Canada) have signed a global original equipment manufacturer (OEM) agreement to incorporate IMRIS's iMotion—the company's ceiling-mounted surgical imaging systems that are used in neurosurgical, spinal and soft-tissue procedures— into Magnetom Espree MRI Systems (70cm). The testing took place mostly in IMRIS's factory in Canada7 with assistance from Siemens Medical's staff. “The magnet is suspended from the ceiling on an MRI-safe crane. The magnet can then be moved from room to room,” explained Ed Gunning, marketing manager of cardiac and interventional MRI in the MRI division of Siemens Medical. This ability allows the advanced technology to be present in multiple locations. Additionally, the combination of Siemens Medical's diagnostic technology and IMRIS's surgical innovations help surgeons remove diseased tissue more efficiently, reduce damage to healthy tissue and decrease visits to the operating room (OR) for subsequent surgeries. IMRIS President David Graves added, “By offering a system that can be used in the OR as well as the diagnostic-imaging department, a facility can realize a significantly improved return on investment”.8
Breast MRI Aurora Imaging Technology offers a dedicated 1.5T breast MRI, featuring a 64cm magnet bore and an enlarged elliptical focal point that enables imaging of both breasts, lymph nodes and a segment of the chest in a single bilateral scan. Enhancements include: Ultra RODEO Plus uses specialized pulse sequences to suppress the visualization of fat and normal ductal tissue; AuroraCAD automatically
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recognizes and compensates for patient motion artifacts and distortions. It also simultaneously displays multiple image views and completes multiplanar reformats and maximum intensity projections (MIP).9
Upright MRI Fonar has a niche in orthopedic applications, particularly as they relate to the spine. The company has over 100 such upright systems installed, mostly in the U.S. Recent efforts are aimed to extend its uses to various cardiac applications. True Flow Imaging of the cardiovascular system is designed to provide information about the size of the right ventricle as an indicator of pulmonary hypertension. The patient would sit during the scan. Those with valvular heart disease might be better assessed, as they are standing in their normal physiologic posture. Also benefiting might be patients with myocardial ischemia resulting from coronary artery disease, as well as candidates for angioplasty or bypass surgery being assessed for coronary blood flow and patients with peripheral venous insufficiency.10
64-slice CT & 3T MRI Scanners Installation in U.S. & Canada Companies\Imaging Systems
64-slice CT
3T MRI
~600
~170
Siemens Medical Solutions (Malvern, PA)
~350
~123
Philips Medical Systems (Andover, MA)
~420
~62
General Electric Healthcare (Waukesha, WI)
Toshiba America Medical Systems (Tustin, CA)
~200
-
Total Installations
~1570
~355
*Numbers are based on vendor information and estimate
Section for MR Technologists The 15th annual meeting of the SMRT11 was held in Seattle, Washington, May 5 -7, 2006: “Soaring to New Heights in MR Education”. Over 300 technologists attended the sessions, enjoyed excellent presentations and reviewed exceptional posters. The meeting began Friday evening with the Poster Walking Tour. The followings were among an impressive lineup of posters presented: «
Cindy Comeau: “Clinical Utility of Time Resolved Imaging in the Evaluation of Peripheral Vascular Malformations.” (1st Place Clinical Focus Poster Award)
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Michelle Garcia: “Managing Technical Factors Affecting Spectral Quality of Endorectal Prostate MRS at 1.5T” (3rd Place Clinical Focus Poster Award)
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Christine Mancini: “Quantitative Infarct Sizing in the Presence of Microvascular Obstruction.” (2nd Place Clinical Focus Poster Award)
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John Posh: “The Role of MRI in the Evaluation of Mummified Human Remains Preserved with Arsenic.”
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Susan Ryan: “Chiari Malformations Pathophysiology Redefined Using MRI Based Flow Measurements as They Relate to Intracranial Compliance (ICC)” (1st Place Research Focus Poster Award)
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Anne Marie Sawyer: “Exit Forms at 1.5T and 3T: Human Experience in MR Examinations.” (3rd Place Research Focus Poster Award)
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Julie Strandt-Peay: “MR Safety Training – Implementing a Program in the Research Environment.” (2nd Place Research Focus Poster Awards)
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Robin Valentine: “Regional Fat Deposition Assessed by MR: The Effect of Weight Loss.”
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Tse Woon Ng: “The Feasibility and Validity of Using MRI to Assess the Right Ventricular Function.”
As part of its mission to recognize and reward exemplary work by technologists worldwide, the SMRT also awards the President’s Award, as well as first, second, third place clinical and research focus awards to the best among the 56 MR abstracts submitted. Winners, as chosen by the Education Committee through a blinded process, were offered 10-20 minutes to present their proffered papers during the annual meeting. This year’s top honor, President’s Award, was given to a group of Canadian MR research technologists headed by Caron Murray of Sunnybrook and Women’s College Health Sciences Center for her presentation titled: “Intermittent Fat Saturation and K-Space Reordering in Breast MRI”. The Saturday morning session: “Trends in MR Diffusion Imaging” were given by Mike Moseley, Ph.D., and Adrian Knowles, R.T., to provide the latest advances in MR diffusion imaging of the brain and the body. After the coffee break, Gina Greenwood, R.T.(R)(MR), B.S., gave her very informative presentation on: “Colorful Communication – the nuts-and-bolts of MRI.” The Saturday afternoon session started with a 3T Update Forum, followed by a series of half hour 3T MRI presentations on pediatric, cardiac and body imaging as well as on clinical neuroimaging. The Sunday morning’s session was moderated by Canadian trained MRI technologist and manager of the Massachusetts Institute of Technology Brain Imaging Center Steven P. Shannon. The breast MR presentations were given by Connie Lehman, M.D. and Michael Coles, R.T. The topics after the coffee break centered around the ever-critical important area of MR safety with two experts in the field: Dr. Frank Shellock and Dr. Tobias Gilk. The afternoon session on Sunday was filled with another series of very interesting topics presented by MR technologists: « James Stuppino: “Economics, Design & Marketing Considerations of Your MRI Center” & “MRI Planning for Gamma Knife Radiotherapy”. «
Maureen Ainslie: “Imaging for Clinical Trials”.
Then was followed by Dr. Rasmus Birn’s update on the latest in functional MRI. The last session of this year’s annual meeting included: « A forum on how MR technologist/radiographers are educated worldwide with representatives from U.S., Canada, U.K., Australia and Europe «
MR Primary Pathway Summit Meeting, co-chaired by Luann Culbreth, RT(R)(MR)(QM), M.Ed & Mark Spooner, RT(R)(MR)(CT), B.P.S. of the SMRT Educational Standards Ad-Hoc Committee, with invited guest presentations by:
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Ginny Hasselhuhn, B.S., R.T.(R), of the American Registry of Radiologic Technologists (ARRT).
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Kevin Powers, Ed.S., R.T.(R)(M), of the American Society for Radiologic Technologists (ASRT).
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Joanne Greathouse, Ed.S., R.T.(R), FASRT, FAERS, of the Joint Review Committee in Radiologic Technology (JRCERT).
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Luann Culbreth, RT(R)(MR)(QM), M.Ed., of the Association of Educators in Radiologic Sciences (AERS) & ARRT.
full extent of injuries, providing surgeons with the information they need when deciding whether or not to operate. «
PET/CT Better at Detecting Ovarian Cancer than PET or CT Alone. Dr. Sunit Sebastian of the Massachusetts General Hospital (Boston) reviewed 54 body CT, PET, and PET/CT examinations on 53 patients with ovarian cancer who were being evaluated for tumor recurrence and discovered that PET/CT’s accuracy (49/53, 92%) was higher than either CT (44/53, 83%) or PET alone (41/53, 77%).
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High-Powered MRI Compares with Arthroscopy for Shoulder Injuries. Dr. Thomas Magee from the Neuroskeletal Imaging Institute (Merritt Island, FL) reviewed the shoulder MRIs obtained with a 3T magnet of 100 consecutive patients and discovered MRI had a high correlation with what is found at surgery. His study demonstrates that diagnosing tears can be done satisfactorily without arthroscopy, sparing many patients from surgery.
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MR Cystography Potential Screening Exam for Ureteral Reflux. The Changi General Hospital in Singapore and the University of California, San Francisco, teamed forces to take a closer look at patients with VUR detected by conventional x-ray cystography who also underwent MR cystography. According to Dr. Hui-Seong’s study, the two methods were concordant for 80% of the ureters and the remaining 20% was split, with MR cystography detecting VUR in one ureter and x-ray cystography detecting it in the other.
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Noninvasive Staging of Fibrosis Possible with Combined Contrast-Enhanced MRI. A study conducted at the University of California, San Diego, found that accurate noninvasive staging of liver fibrosis in nonalcoholic fatty liver disease (NAFLD) was possible with combined contrast-enhanced (CCE) MRI. Dr. Claude Sirlin’s team used two contrast agents with complementary mechanisms—iron particles to darken the background liver and gadolinium to brighten the fibrosis—and deemed the procedure repeatable and possibly more accurate than any other noninvasive method for assessing liver fibrosis.
American Roentgen Ray Society Annual Meeting ARRS of Leesburg, VA’s Annual Meeting was held April 30 – May 5 in Vancouver, B.C. There were 29 scientific sessions, each featuring six to 12 abstract presentations. The ARRS awarded three recipients of the 2006 Gold Medal for Distinguished Service (ARRS’ highest honor): N. Reed Dunnick, MD, of the University of Michigan in Ann Arbor; Frieda Feldman, MD, of the Columbia University College of Physicians and Surgeons in New York; and Britton Chance, PhD, MD (Hon), of the University of Pennsylvania in Philadelphia 12 Dr. Chance, an Olympic gold medalist (Helsinki,1952), is the father of the field of optical imaging; in addition, his lifetime contributions to the field of MR were recognized in 1988 as Gold Medalist by the Society of magnetic Resonance in Medicine (USA) and again in 2005 when Dr. Chance delivered the Lauterbur Endowed Lecture at the Annual Meeting of the International Society for Magnetic Resonance in Medicine.13 His current research interests include cancer detection, cognitive imaging, skeletal muscle function, cardiac myopathy and cancer heterogeneity, all investigated using MR and optical spectroscopy and imaging.14 Technological advances fueled many interesting research presentations at ARRS Annual Meeting. The followings are some of the highlights: « Common Interventional Radiology Procedures Can be Performed at Lower Dose. Safe and effective interventional radiology procedures are possible even when the radiation dose is reduced by as much as 88 percent, according to Dr. Brian Lucey of the Boston University Medical Center. Analyzing CTguided biopsy, needle aspiration, or catheter placement procedures conducted on 291 patients, his team of researchers found it possible to accurately perform such image-guided interventional procedures even with slightly “muddy” images. To perform the procedure successfully, clinicians began with a very low dose, increasing it until the procedure is feasible. «
Lower Doses for Abdominal CT of Children Don’t Impact Image Quality. Dr. Soroosh Mahboubi of the Children's Hospital of Philadelphia found that abdominal CT radiation dose can be reduced by 60% without compromising image quality. When reviewing abdominal scans from 74 children, Dr. Mahboubi’s group found that, on average, modulating the tube current to account for body symmetry reduced the radiation dose by 15% over the usual weight-adjusted dose.
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Latest CT Technology Improves Diagnosis in Emergency Department (ED). Dr. Craig Barnes and radiologists at Brenner Children's Hospital (Winston-Salem, NC) are using 64-slice CT and both 2D and 3D images to assess and treat trauma patients in the hospital's ED. Employing 2D or 3D imaging makes it easier to locate any ruptures and define the
Diffusion Tensor MRI (DTI) Showed Reorganization of Brain White Matter in the Recovery after 19 years in a Minimally Conscious State J. Clin. Invest. 2006;116:2005-2011 reported the results of DTI and PET scans and the follow-up 18 months later of an unconscious man who recovered language and motor function, after almost two decades in a coma. DTI is capable of characterizing specific white matter pathologies such as atrophy and diffuse axonal injury. The preferential diffusion of water in myelinated white matter locally coincides with the direction of white matter fiber bundles in the brain. At initial evaluation, the patient already had regained limited movement and speech, DTI indicated fractional anisotropy and increased fiber directionality in the medial, parietal, occipital (MPO) areas, which correlated well with an increase in glucose metabolism as measured by FDG-PET. According to the lead biomedical research team at Cornell University in the multicenter, multidisciplinary study: “The initial spike in anisotropy was a transitional stage of an ongoing axonal sprouting process. Once the new fiber connections were made, axons thinned out by sprouting toward other targets.” Between the first and second PET and DTI
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scans, researchers observed a 20-50% increase in glucose uptake in the MPO areas, which might reflect the neuronal regrowth; improved directionality in the white matter fibers, especially in the inferior part of the cerebellar vermis of the patient paralleling his clinical recovery showing markedly improved motor function and likely very soon followed by cognitive improvement.
IEEE International Symposium on Biomedical Imaging The IEEE International Symposium on Biomedical Imaging was held in Washington, D.C. April 6-9, 2006.15 The general imaging meeting included oral and poster sessions on MRI as well as CT, ultrasound, PET and MEG. Some excellent plenary sessions included: those from Dr. Rakesh Jain of Harvard Medical School on “Molecular, Cellular, Anatomical and Functional Imaging of Tumors In Vivo: From Bench to Bedside and Back” and Dr. Peter Hunter of the University of Auckland, New Zealand, on “Computation Physiology and the Physiome Project” which were very interesting. Dr. Jain summarized his 30 years of research in the field of tumor research. He presented the paradox of the increased effectiveness of combined anti-angiogenesis drugs with chemotherapy (the antio-angiogenesis drug supposedly kills blood vessels, but the chemotherapy needs vessels in order for the drug to reach the tumor). His hypothesis was that antiogenesis drugs actually “normalize” blood flow to the tumors instead of killing all vessels, thus explaining the increased effectiveness of chemotherapy.
Dentistry of the Future Shining a laser around in one’s mouth as part of a routine dental examination to find and monitor potential tooth decay sites could be a thing of the future in the dental clinic and the central theme of a recent article: “Detection of early dental caries using polarized Raman spectroscopy” published in Optics Express,18 based on research by scientists at NRC-IBD along with dental collaborators from the University of Manitoba and Dalhousie University. While conventional dental x-rays are not sensitive enough to see surface caries lesions at their earliest stages, this study demonstrated that polarized Raman spectroscopy is able to detect minor structural changes at the molecular level caused by tooth demineralization. The strength of polarized Raman spectroscopy not only lies with its biochemical specificity but also its sensitivity toward structural difference such as molecular alignment and degree of crystallinity, thus providing useful information for characterizing diseased tissue structure. In the case of dental caries detection, polarization anisotropy derived from the polarized Raman spectra of sound and carious teeth showed substantial differences; therefore it can be used as a quantitative measure to assess the extent of tooth demineralization. This parameter is not only useful for dentists to formulate treatment plans for their patients but will also enable them to monitor the progress of dental fluoride treatment. Such information is not currently available to dentists through existing dental diagnostic tools. The plan is to couple polarized Raman spectroscopy with optical coherence tomography (OCT) into a common diagnostic device.
First in the World! Another highlight was a special session on open source image analysis software, an initiative by the National Alliance for Medical Imaging Computing.16
Biomedical Optics The Optical Society of America's Biomedical Optics Topical Meeting was held March 19-22, 2006. The conference was focused on optical imaging modalities, including diffuse optical tomography, molecular imaging, confocal techniques and optical coherence methods. By far, the meeting was concentrated on diffuse optical topographic of breasts as an adjunct alternative to x-ray mammography for breast cancer screening. Several large research groups and companies are actively developing this area. Advanced Research Technologies (ART), a Canadian company, is currently collecting clinical breast tomography data with their custom tomography system. Other applications include cerebral tomography of premature neonates to detect intra-cranial hemorrhages, which are a common clinical problem in this population, and imaging of small animal models for use in drug discovery. Several companies are currently marketing small animal imaging systems using fluorescence of endogenous chromophores and exogenous labeled biomarkers, near infrared, life-time fluorescence, time of flight for optical density and x-ray to assist companies in drug discovery using small animal models. Molecular, confocal, and low coherence imaging sessions focused on drug discovery application using small animal models, sub-cellular measurements and modeling of tissue optical properties of scattering and absorption.17
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Cardiac surgeons and cardiologists at the St. Paul’s Hospital in Vancouver, recently performed the world’s first minimally invasive “beating heart” aortic valve-replacement surgery. The elderly patient would not have been able to endure open-heart surgery, the traditional method of replacing heart valves. Most importantly, this minimally invasive aortic valve implantation was able to improve the health of a patient who had no other options. Traditional heart valve replacement surgery usually requires a long chest incision to enable surgeons to expose the heart, which is then temporarily stopped while the valve is replaced and sutured into place. A heart lung bypass machine is required to keep the patient’s blood circulating until heart function is restored. Instead, with this approach, surgeons used a special valve that folds to the diameter of a pencil and is inserted through a 5cm incision between two ribs. Guided by moving x-ray and echocardiography, the team inserted the valve through the base of the patient’s heart. When in place, the valve was unfolded, pushing the existing valve tissue aside. These procedures will be offered on compassionate grounds to patients who are too frail to survive open-heart valve replacement surgery. Later, they could be available to patients for whom open-heart surgery is possible but considered high risk. A manuscript describing the technique, “Transapical Aortic Valve Implantation in Man” by Dr. John G. Webb, et. al. has recently been published in the Journal of Thoracic and Cardiovascular Surgery.19
Cardiovascular MR The Annual Meeting of the Society for Cardiovascular Magnetic Resonance (SCMR), was held January 20-22, 2006 in Miami, Florida, at the Doral Golf Resort - home of the PGA's Ford Championship and “The Blue Monster”.20 The conference focused
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on clinical cardiac MR imaging/spectroscopy, discussing existing and new methods used in a typical cardiac exam, including dynamic CINE and tagged MRI, rest and stress function and perfusion, late enhancement of gadolinium contrast, as well as angiography and flow exams. There were some interesting contrast and molecular MRI talks, as well as modality comparisons between MR and CT/SPECT/PET and their advantages and disadvantages. Two of the best presentations were given by Hajime Sakuma (Mie University, Japan) on MRA of coronaries and by Daniel Berman (Cedars Sinai Medical Center, USA) on CT of coronaries. There was consensus that the late enhancement technique is by far the best method of diagnosing myocarditis, and seems to be a favorite of all cardiologists. There was also agreement that coronary MRI and angiography is where more research effort is required as this still lags behind what CT can do in this area. If MR of coronaries could match the diagnostic capabilities of CT, then MR would be a onestop shop for clinical cardiac assessment.
Open Access to Products of Health Research The Canadian Institutes of Health Research (CIHR) is developing an ‘open access’ policy. CIHR is initiating a process to develop a research policy that will promote access to the knowledge and resources generated from CIHR-funded research. Currently, CIHR encourages recipients of research support to make the results of all research publicly available. CIHR’s aim is to establish a policy that will both help researchers gain access to the products of research and support CIHR's efforts in facilitating the translation and use of knowledge, while taking into account ethical and legal considerations. Furthermore, as a recipient of public funds there is an obligation to Canadians to ensure that the results and products of research supported by CIHR are disseminated as widely as possible so that all parties benefit from these research outcomes.21
MedEffect: Canada Offers Database of Adverse Drug Reactions This database can be used to access information concerning suspected adverse reactions to Canadian marketed health products of pharmaceuticals, biologics (including blood products and therapeutic and diagnostic vaccines), natural health products, and radiopharmaceuticals, as reported to Health Canada through voluntary and mandatory reporting measures. Information on this website includes data submitted from 1965 to June 2005.22
ACKNOWLEDGEMENTS The author would like to thank Dr. Britton Chance for his many gracious remarks and encouragement years ago as it’s also my honour to have Dr. Chance23 (biography in the Appendix) as my University of British Columbia PhD thesis external examiner, as well as the entire NRC-IBD team and RRC MRI/S Program graduates for providing much of the information for this update, Renee Lien and Anthony Lee for proofreading the manuscript.
APPENDIX Dunnick, Feldman, and Chance named 2006 ARRS Gold Medalists The ARRS has announced the recipients of the 2006 Gold Medal for Distinguished Service. They are N. Reed Dunnick, MD, of the University of Michigan in Ann Arbor; Frieda Feldman, MD, of the Columbia University College of Physicians and Surgeons in New York; and Britton Chance, PhD, MD (Hon), of the University of Pennsylvania in Philadelphia. The ARRS Gold Medal is the society’s highest honor. The awards will be presented during the 2006 ARRS Annual Meeting in Vancouver, BC, Canada on May 3.12 Dr. Britton Chance Dr. Chance is Eldridge Reeves Johnson University Professor Emeritus of Biophysics, Physical Chemistry, and Radiologic Physics at the University of Pennsylvania. He received his Ph.D. from the University of Pennsylvania and his D.Sc. from Cambridge University. He has a multitude of scientific and engineering accomplishments to his name, ranging from the development of the stopped-flow method for observing rapid biological reactions to pioneering research into cell bioenergetics, including the formation of enzymesubstrate compounds.24-25 Dr. Chance and colleagues obtained the first nuclear magnetic resonance (NMR) spectra from excised and in situ heart, brain and liver in 1977-1978, and the first NMR spectra from exercised human limb in 1980. His lifetime contributions to the field of NMR were recognized in 2005 when Dr. Chance delivered the Lauterbur endowed lecture at the annual meeting of the International Society for Magnetic Resonance in Medicine. He has received more than 50 awards and honors, including the National Medal of Science, the College of Physicians Gold Medal for Distinguished Service to Medicine and the National Institutes of Health Christopher Columbus Discovery Award in Biomedical Research. Dr. Chance is the father of the field of optical imaging. His current research interests include cancer detection, cognitive imaging, skeletal muscle function, cardiac myopathy and cancer heterogeneity.26 In 2005, Dr. Chance and colleagues published the results of a six-year, two-population study of a handheld, noninvasive breast cancer detector using near infrared technology that achieved a sensitivity/specificity (ROC) of 94.6%. Dr. Chance has published more than 1,400 refereed papers and given more than 750 conference presentations. He holds 10 honorary degrees, including an MD from the Karolinska Institutet (home of the Nobel Prize Committee for Physiology or Medicine). He is founder and president of Non-Invasive Technology, Inc. Dr. Chance’s avocation is sailing. Even when he was just a teenager, he invented an autosteering device that detected deviations in a ship's course and generated a feedback signal to redirect the ship's steering mechanisms. He has won numerous championships, including the Olympic Gold Medal at Helsinki in 1952, as a member of the U.S. yacht Olympic team.
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GE Healthcare and Mayo Clinic Announce Collaboration To Develop Clinical High-Field Body MRI. Available at: http://egems.gehealthcare.com/proom/ internet/NewsandEvents.jsp?release_id=10549 Accessed: August 16, 2006. Siemens and Massachusetts General Hospital Develop Prototype 128channel MRI System Based on Tim Technology. Available at: http://www.medical.siemens.com/webapp/wcs/stores/servlet/PressRelease View?catalogId=-1&catTree=100005,13839,17709&langId=1&pageId=74338&storeId=10001 Accessed: August 16, 2006. Biophan and Siemens AG Announce a Declaration of Intent for Strategic Collaboration on Advanced Interventional MRI Technology. BiophanEurope to Enter into Negotiations for a Joint R&D Agreement with Siemens Medical Solutions MRI Division. Available at: http://www.biophan.com/pr/2006/03/033006Siemens.html Accessed: August 16, 2006.
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New MRI Technologies for Diagnostic Applications. Available: http://www.ibd.nrc.ca/ibd_external/research/m_r_tech/index.html Accessed: August 16, 2006.
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Ko ACT, Choo-Smith LP, Hewko M and Sowa MG. Detection of Early Dental Caries Using Polarized Raman Spectroscopy. Optics Express 2006;14(1):203-215. Available at: http://www.opticsexpress.org/ ViewMedia.cfm?id=86900&seq=0 Accessed: August 16, 2006.
19. Webb JG, et. al. Transapical Aortic Valve Implantation in Man. Journal of Thoracic and Cardiovascular Surgery 1006;131:1194-1196. 20.
Society for Cardiovascular Magnetic Resonance Ninth Annual Scientific Sessions. Available at: http://www.scmr.org/meetings/scmr2006.shtml Accessed: August 16, 2006.
21. CIHR Policy in Development – Access to Products of Research. Available at: http://www.cihr-irsc.gc.ca/e/30818.html Accessed: August 16, 2006. 22.
Canadian Adverse Drug Reaction Monitoring Program (CADRMP) Online Query and Data Extract Updated to Include First Quarter 2006 Data (1965 - 03/2006) Available at: http://www.hc-sc.gc.ca/dhpmps/medeff/databasdon/index_e.html Accessed: August 16, 2006.
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Siemens and IMRIS Partner to Offer Ceiling-mounted MRI. Available at: http://www.medical.siemens.com/webapp/wcs/stores/servlet/PressRelease V i e w ? c a t a l o g I d = - 1 & c a t Tr e e = 1 0 0 0 0 5 , 1 3 8 3 9 & l a n g I d = 1&pageId=72164&storeId=10001 Accessed: August 16, 2006.
Institute for Corean-American Studies: Britton Chance Biographic Sketch. Available at: http://www.icasinc.org/bios/chance.html Accessed: August 16, 2006.
24.
Kresge N, Simoni RD and Hill RL. Britton Chance: Olympian and Developer of Stop-Flow Methods. J. Biol. Chem. 2004;279(50):109-111. Available at: http://www.jbc.org/cgi/content/full/279/50/e10?maxtoshow=& Accessed: August 16, 2006.
25.
Chance B. The Stopped-flow Method and Chemical Intermediates in Enzyme Reactions – a Personal Essay. Photosynthesis Research 2004;80:387-400. Available at: http://www.life.uiuc.edu/govindjee/history/ Chance2004.pdf Accessed: August 16, 2006.
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Chance B, Nioka S and Chen Y. Shinning New Light on Brain Function. Near-IR Systems Offer Handheld and Even Non-contact Methods for Monitoring Brain Functions Like Problem Solving. Spie’s Oemagazine, July, 2003;16-20. Available at: http://oemagazine.com/fromThemagazine/ jul03/brain.html Accessed: August 16, 2006.
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Chance of a Lifetime – Britton Chance’s Research has Transformed the Field of Biomedical Optics. Available at: http://oemagazine.com/ fromTheMagazine/apr01/spie_chance.html Accessed: August 16, 2006.
at:
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Interventional MRI Collaboration Biophan Technologies Inc (West Henrietta, NY) has announced a strategic research collaboration between Siemens Medical Solutions’ MRI Division (Erlangen, Germany) and Biophan Europe GmbH. The goal is to provide new solutions in interventional MRI and MRI-assisted minimally invasive surgeries. The collaboration is for the further development and commercialization of potentially complementary MRI technologies, including MR compatible pacemakers. Siemens Medical has developed a new MRI-scanning technology with aperture configurations, and Biophan is attempting to enable effective MRI visualization of implanted medical devices, including heart valves, coronary and peripheral stents, and vena cava filters.3
Strategic Partnership for Function MRI Neurognostics Inc (Milwaukee, WI) has signed a strategic partnership agreement with Medical Numerics Inc. (Sterling, VA)4 to enhance the company's offering of functional MRI (fMRI) tools and applications, which is based on Medical Numerics' proprietary fMRI tool set and Neurognostics' MindState fDPD fMRI application software. With fMRI, clinicians can measure brain function, enabling a real look at the way the brain works. The technology has a number of promising clinical applications, specifically in the areas of presurgical brain mapping for assessing neurological risk, early identification
of psychiatric and central nervous system disorders and measurement of the effects of therapies in neurodegenerative and neurodevelopmental disorders.5
Hardware-Independent MR The MR Technology Group of NRC-IBD (West) has been working on an integrated MR console and MR physics simulation system. The system consists of a research MR console with a full-function hardware-independent pulse programming environment, and a parallel computer cluster running full Bloch equation simulations on a 3D digitally-defined spin phantom. This allows side-by-side comparisons of experimental vs. simulated data for any pulse sequence. The simulator employs multiple spins per voxel, which allows the development of stochastic tissue models and the simultaneous simulation of multiple physical phenomena. The console sequencer software executes on a Pentium III running a real-time operating system (RTOS). A full pulse sequence library, including over 40 imaging, spectroscopy and utility sequences, has been implemented. The console has been successfully installed on a 9.4T/21cm animal MR imaging system in Edmonton.6 In addition, the University of Alberta Hospital, Stollery Children’s Hospital, the University of Alberta Research Center and the Mazankowski Heart Institute have two Siemens 1.5T clinical MRI, one 1.5T research MRI, soon to be installed a 1.5T Intra-operative MRI and a dedicated 1.5T Cardiac MRI.
Ceiling-mounted MRI Siemens Medical Solutions (Malvern, Pa) and IMRIS Inc. (Winnipeg, MB, Canada) have signed a global original equipment manufacturer (OEM) agreement to incorporate IMRIS's iMotion—the company's ceiling-mounted surgical imaging systems that are used in neurosurgical, spinal and soft-tissue procedures— into Magnetom Espree MRI Systems (70cm). The testing took place mostly in IMRIS's factory in Canada7 with assistance from Siemens Medical's staff. “The magnet is suspended from the ceiling on an MRI-safe crane. The magnet can then be moved from room to room,” explained Ed Gunning, marketing manager of cardiac and interventional MRI in the MRI division of Siemens Medical. This ability allows the advanced technology to be present in multiple locations. Additionally, the combination of Siemens Medical's diagnostic technology and IMRIS's surgical innovations help surgeons remove diseased tissue more efficiently, reduce damage to healthy tissue and decrease visits to the operating room (OR) for subsequent surgeries. IMRIS President David Graves added, “By offering a system that can be used in the OR as well as the diagnostic-imaging department, a facility can realize a significantly improved return on investment”.8
Breast MRI Aurora Imaging Technology offers a dedicated 1.5T breast MRI, featuring a 64cm magnet bore and an enlarged elliptical focal point that enables imaging of both breasts, lymph nodes and a segment of the chest in a single bilateral scan. Enhancements include: Ultra RODEO Plus uses specialized pulse sequences to suppress the visualization of fat and normal ductal tissue; AuroraCAD automatically
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recognizes and compensates for patient motion artifacts and distortions. It also simultaneously displays multiple image views and completes multiplanar reformats and maximum intensity projections (MIP).9
Upright MRI Fonar has a niche in orthopedic applications, particularly as they relate to the spine. The company has over 100 such upright systems installed, mostly in the U.S. Recent efforts are aimed to extend its uses to various cardiac applications. True Flow Imaging of the cardiovascular system is designed to provide information about the size of the right ventricle as an indicator of pulmonary hypertension. The patient would sit during the scan. Those with valvular heart disease might be better assessed, as they are standing in their normal physiologic posture. Also benefiting might be patients with myocardial ischemia resulting from coronary artery disease, as well as candidates for angioplasty or bypass surgery being assessed for coronary blood flow and patients with peripheral venous insufficiency.10
64-slice CT & 3T MRI Scanners Installation in U.S. & Canada Companies\Imaging Systems
64-slice CT
3T MRI
~600
~170
Siemens Medical Solutions (Malvern, PA)
~350
~123
Philips Medical Systems (Andover, MA)
~420
~62
General Electric Healthcare (Waukesha, WI)
Toshiba America Medical Systems (Tustin, CA)
~200
-
Total Installations
~1570
~355
*Numbers are based on vendor information and estimate
Section for MR Technologists The 15th annual meeting of the SMRT11 was held in Seattle, Washington, May 5 -7, 2006: “Soaring to New Heights in MR Education”. Over 300 technologists attended the sessions, enjoyed excellent presentations and reviewed exceptional posters. The meeting began Friday evening with the Poster Walking Tour. The followings were among an impressive lineup of posters presented: «
Cindy Comeau: “Clinical Utility of Time Resolved Imaging in the Evaluation of Peripheral Vascular Malformations.” (1st Place Clinical Focus Poster Award)
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Michelle Garcia: “Managing Technical Factors Affecting Spectral Quality of Endorectal Prostate MRS at 1.5T” (3rd Place Clinical Focus Poster Award)
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Christine Mancini: “Quantitative Infarct Sizing in the Presence of Microvascular Obstruction.” (2nd Place Clinical Focus Poster Award)
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John Posh: “The Role of MRI in the Evaluation of Mummified Human Remains Preserved with Arsenic.”
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Susan Ryan: “Chiari Malformations Pathophysiology Redefined Using MRI Based Flow Measurements as They Relate to Intracranial Compliance (ICC)” (1st Place Research Focus Poster Award)
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Anne Marie Sawyer: “Exit Forms at 1.5T and 3T: Human Experience in MR Examinations.” (3rd Place Research Focus Poster Award)
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Julie Strandt-Peay: “MR Safety Training – Implementing a Program in the Research Environment.” (2nd Place Research Focus Poster Awards)
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Robin Valentine: “Regional Fat Deposition Assessed by MR: The Effect of Weight Loss.”
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Tse Woon Ng: “The Feasibility and Validity of Using MRI to Assess the Right Ventricular Function.”
As part of its mission to recognize and reward exemplary work by technologists worldwide, the SMRT also awards the President’s Award, as well as first, second, third place clinical and research focus awards to the best among the 56 MR abstracts submitted. Winners, as chosen by the Education Committee through a blinded process, were offered 10-20 minutes to present their proffered papers during the annual meeting. This year’s top honor, President’s Award, was given to a group of Canadian MR research technologists headed by Caron Murray of Sunnybrook and Women’s College Health Sciences Center for her presentation titled: “Intermittent Fat Saturation and K-Space Reordering in Breast MRI”. The Saturday morning session: “Trends in MR Diffusion Imaging” were given by Mike Moseley, Ph.D., and Adrian Knowles, R.T., to provide the latest advances in MR diffusion imaging of the brain and the body. After the coffee break, Gina Greenwood, R.T.(R)(MR), B.S., gave her very informative presentation on: “Colorful Communication – the nuts-and-bolts of MRI.” The Saturday afternoon session started with a 3T Update Forum, followed by a series of half hour 3T MRI presentations on pediatric, cardiac and body imaging as well as on clinical neuroimaging. The Sunday morning’s session was moderated by Canadian trained MRI technologist and manager of the Massachusetts Institute of Technology Brain Imaging Center Steven P. Shannon. The breast MR presentations were given by Connie Lehman, M.D. and Michael Coles, R.T. The topics after the coffee break centered around the ever-critical important area of MR safety with two experts in the field: Dr. Frank Shellock and Dr. Tobias Gilk. The afternoon session on Sunday was filled with another series of very interesting topics presented by MR technologists: « James Stuppino: “Economics, Design & Marketing Considerations of Your MRI Center” & “MRI Planning for Gamma Knife Radiotherapy”. «
Maureen Ainslie: “Imaging for Clinical Trials”.
Then was followed by Dr. Rasmus Birn’s update on the latest in functional MRI. The last session of this year’s annual meeting included: « A forum on how MR technologist/radiographers are educated worldwide with representatives from U.S., Canada, U.K., Australia and Europe «
MR Primary Pathway Summit Meeting, co-chaired by Luann Culbreth, RT(R)(MR)(QM), M.Ed & Mark Spooner, RT(R)(MR)(CT), B.P.S. of the SMRT Educational Standards Ad-Hoc Committee, with invited guest presentations by:
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Ginny Hasselhuhn, B.S., R.T.(R), of the American Registry of Radiologic Technologists (ARRT).
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Kevin Powers, Ed.S., R.T.(R)(M), of the American Society for Radiologic Technologists (ASRT).
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Joanne Greathouse, Ed.S., R.T.(R), FASRT, FAERS, of the Joint Review Committee in Radiologic Technology (JRCERT).
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Luann Culbreth, RT(R)(MR)(QM), M.Ed., of the Association of Educators in Radiologic Sciences (AERS) & ARRT.
full extent of injuries, providing surgeons with the information they need when deciding whether or not to operate. «
PET/CT Better at Detecting Ovarian Cancer than PET or CT Alone. Dr. Sunit Sebastian of the Massachusetts General Hospital (Boston) reviewed 54 body CT, PET, and PET/CT examinations on 53 patients with ovarian cancer who were being evaluated for tumor recurrence and discovered that PET/CT’s accuracy (49/53, 92%) was higher than either CT (44/53, 83%) or PET alone (41/53, 77%).
«
High-Powered MRI Compares with Arthroscopy for Shoulder Injuries. Dr. Thomas Magee from the Neuroskeletal Imaging Institute (Merritt Island, FL) reviewed the shoulder MRIs obtained with a 3T magnet of 100 consecutive patients and discovered MRI had a high correlation with what is found at surgery. His study demonstrates that diagnosing tears can be done satisfactorily without arthroscopy, sparing many patients from surgery.
«
MR Cystography Potential Screening Exam for Ureteral Reflux. The Changi General Hospital in Singapore and the University of California, San Francisco, teamed forces to take a closer look at patients with VUR detected by conventional x-ray cystography who also underwent MR cystography. According to Dr. Hui-Seong’s study, the two methods were concordant for 80% of the ureters and the remaining 20% was split, with MR cystography detecting VUR in one ureter and x-ray cystography detecting it in the other.
«
Noninvasive Staging of Fibrosis Possible with Combined Contrast-Enhanced MRI. A study conducted at the University of California, San Diego, found that accurate noninvasive staging of liver fibrosis in nonalcoholic fatty liver disease (NAFLD) was possible with combined contrast-enhanced (CCE) MRI. Dr. Claude Sirlin’s team used two contrast agents with complementary mechanisms—iron particles to darken the background liver and gadolinium to brighten the fibrosis—and deemed the procedure repeatable and possibly more accurate than any other noninvasive method for assessing liver fibrosis.
American Roentgen Ray Society Annual Meeting ARRS of Leesburg, VA’s Annual Meeting was held April 30 – May 5 in Vancouver, B.C. There were 29 scientific sessions, each featuring six to 12 abstract presentations. The ARRS awarded three recipients of the 2006 Gold Medal for Distinguished Service (ARRS’ highest honor): N. Reed Dunnick, MD, of the University of Michigan in Ann Arbor; Frieda Feldman, MD, of the Columbia University College of Physicians and Surgeons in New York; and Britton Chance, PhD, MD (Hon), of the University of Pennsylvania in Philadelphia 12 Dr. Chance, an Olympic gold medalist (Helsinki,1952), is the father of the field of optical imaging; in addition, his lifetime contributions to the field of MR were recognized in 1988 as Gold Medalist by the Society of magnetic Resonance in Medicine (USA) and again in 2005 when Dr. Chance delivered the Lauterbur Endowed Lecture at the Annual Meeting of the International Society for Magnetic Resonance in Medicine.13 His current research interests include cancer detection, cognitive imaging, skeletal muscle function, cardiac myopathy and cancer heterogeneity, all investigated using MR and optical spectroscopy and imaging.14 Technological advances fueled many interesting research presentations at ARRS Annual Meeting. The followings are some of the highlights: « Common Interventional Radiology Procedures Can be Performed at Lower Dose. Safe and effective interventional radiology procedures are possible even when the radiation dose is reduced by as much as 88 percent, according to Dr. Brian Lucey of the Boston University Medical Center. Analyzing CTguided biopsy, needle aspiration, or catheter placement procedures conducted on 291 patients, his team of researchers found it possible to accurately perform such image-guided interventional procedures even with slightly “muddy” images. To perform the procedure successfully, clinicians began with a very low dose, increasing it until the procedure is feasible. «
Lower Doses for Abdominal CT of Children Don’t Impact Image Quality. Dr. Soroosh Mahboubi of the Children's Hospital of Philadelphia found that abdominal CT radiation dose can be reduced by 60% without compromising image quality. When reviewing abdominal scans from 74 children, Dr. Mahboubi’s group found that, on average, modulating the tube current to account for body symmetry reduced the radiation dose by 15% over the usual weight-adjusted dose.
«
Latest CT Technology Improves Diagnosis in Emergency Department (ED). Dr. Craig Barnes and radiologists at Brenner Children's Hospital (Winston-Salem, NC) are using 64-slice CT and both 2D and 3D images to assess and treat trauma patients in the hospital's ED. Employing 2D or 3D imaging makes it easier to locate any ruptures and define the
Diffusion Tensor MRI (DTI) Showed Reorganization of Brain White Matter in the Recovery after 19 years in a Minimally Conscious State J. Clin. Invest. 2006;116:2005-2011 reported the results of DTI and PET scans and the follow-up 18 months later of an unconscious man who recovered language and motor function, after almost two decades in a coma. DTI is capable of characterizing specific white matter pathologies such as atrophy and diffuse axonal injury. The preferential diffusion of water in myelinated white matter locally coincides with the direction of white matter fiber bundles in the brain. At initial evaluation, the patient already had regained limited movement and speech, DTI indicated fractional anisotropy and increased fiber directionality in the medial, parietal, occipital (MPO) areas, which correlated well with an increase in glucose metabolism as measured by FDG-PET. According to the lead biomedical research team at Cornell University in the multicenter, multidisciplinary study: “The initial spike in anisotropy was a transitional stage of an ongoing axonal sprouting process. Once the new fiber connections were made, axons thinned out by sprouting toward other targets.” Between the first and second PET and DTI
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scans, researchers observed a 20-50% increase in glucose uptake in the MPO areas, which might reflect the neuronal regrowth; improved directionality in the white matter fibers, especially in the inferior part of the cerebellar vermis of the patient paralleling his clinical recovery showing markedly improved motor function and likely very soon followed by cognitive improvement.
IEEE International Symposium on Biomedical Imaging The IEEE International Symposium on Biomedical Imaging was held in Washington, D.C. April 6-9, 2006.15 The general imaging meeting included oral and poster sessions on MRI as well as CT, ultrasound, PET and MEG. Some excellent plenary sessions included: those from Dr. Rakesh Jain of Harvard Medical School on “Molecular, Cellular, Anatomical and Functional Imaging of Tumors In Vivo: From Bench to Bedside and Back” and Dr. Peter Hunter of the University of Auckland, New Zealand, on “Computation Physiology and the Physiome Project” which were very interesting. Dr. Jain summarized his 30 years of research in the field of tumor research. He presented the paradox of the increased effectiveness of combined anti-angiogenesis drugs with chemotherapy (the antio-angiogenesis drug supposedly kills blood vessels, but the chemotherapy needs vessels in order for the drug to reach the tumor). His hypothesis was that antiogenesis drugs actually “normalize” blood flow to the tumors instead of killing all vessels, thus explaining the increased effectiveness of chemotherapy.
Dentistry of the Future Shining a laser around in one’s mouth as part of a routine dental examination to find and monitor potential tooth decay sites could be a thing of the future in the dental clinic and the central theme of a recent article: “Detection of early dental caries using polarized Raman spectroscopy” published in Optics Express,18 based on research by scientists at NRC-IBD along with dental collaborators from the University of Manitoba and Dalhousie University. While conventional dental x-rays are not sensitive enough to see surface caries lesions at their earliest stages, this study demonstrated that polarized Raman spectroscopy is able to detect minor structural changes at the molecular level caused by tooth demineralization. The strength of polarized Raman spectroscopy not only lies with its biochemical specificity but also its sensitivity toward structural difference such as molecular alignment and degree of crystallinity, thus providing useful information for characterizing diseased tissue structure. In the case of dental caries detection, polarization anisotropy derived from the polarized Raman spectra of sound and carious teeth showed substantial differences; therefore it can be used as a quantitative measure to assess the extent of tooth demineralization. This parameter is not only useful for dentists to formulate treatment plans for their patients but will also enable them to monitor the progress of dental fluoride treatment. Such information is not currently available to dentists through existing dental diagnostic tools. The plan is to couple polarized Raman spectroscopy with optical coherence tomography (OCT) into a common diagnostic device.
First in the World! Another highlight was a special session on open source image analysis software, an initiative by the National Alliance for Medical Imaging Computing.16
Biomedical Optics The Optical Society of America's Biomedical Optics Topical Meeting was held March 19-22, 2006. The conference was focused on optical imaging modalities, including diffuse optical tomography, molecular imaging, confocal techniques and optical coherence methods. By far, the meeting was concentrated on diffuse optical topographic of breasts as an adjunct alternative to x-ray mammography for breast cancer screening. Several large research groups and companies are actively developing this area. Advanced Research Technologies (ART), a Canadian company, is currently collecting clinical breast tomography data with their custom tomography system. Other applications include cerebral tomography of premature neonates to detect intra-cranial hemorrhages, which are a common clinical problem in this population, and imaging of small animal models for use in drug discovery. Several companies are currently marketing small animal imaging systems using fluorescence of endogenous chromophores and exogenous labeled biomarkers, near infrared, life-time fluorescence, time of flight for optical density and x-ray to assist companies in drug discovery using small animal models. Molecular, confocal, and low coherence imaging sessions focused on drug discovery application using small animal models, sub-cellular measurements and modeling of tissue optical properties of scattering and absorption.17
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Cardiac surgeons and cardiologists at the St. Paul’s Hospital in Vancouver, recently performed the world’s first minimally invasive “beating heart” aortic valve-replacement surgery. The elderly patient would not have been able to endure open-heart surgery, the traditional method of replacing heart valves. Most importantly, this minimally invasive aortic valve implantation was able to improve the health of a patient who had no other options. Traditional heart valve replacement surgery usually requires a long chest incision to enable surgeons to expose the heart, which is then temporarily stopped while the valve is replaced and sutured into place. A heart lung bypass machine is required to keep the patient’s blood circulating until heart function is restored. Instead, with this approach, surgeons used a special valve that folds to the diameter of a pencil and is inserted through a 5cm incision between two ribs. Guided by moving x-ray and echocardiography, the team inserted the valve through the base of the patient’s heart. When in place, the valve was unfolded, pushing the existing valve tissue aside. These procedures will be offered on compassionate grounds to patients who are too frail to survive open-heart valve replacement surgery. Later, they could be available to patients for whom open-heart surgery is possible but considered high risk. A manuscript describing the technique, “Transapical Aortic Valve Implantation in Man” by Dr. John G. Webb, et. al. has recently been published in the Journal of Thoracic and Cardiovascular Surgery.19
Cardiovascular MR The Annual Meeting of the Society for Cardiovascular Magnetic Resonance (SCMR), was held January 20-22, 2006 in Miami, Florida, at the Doral Golf Resort - home of the PGA's Ford Championship and “The Blue Monster”.20 The conference focused
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on clinical cardiac MR imaging/spectroscopy, discussing existing and new methods used in a typical cardiac exam, including dynamic CINE and tagged MRI, rest and stress function and perfusion, late enhancement of gadolinium contrast, as well as angiography and flow exams. There were some interesting contrast and molecular MRI talks, as well as modality comparisons between MR and CT/SPECT/PET and their advantages and disadvantages. Two of the best presentations were given by Hajime Sakuma (Mie University, Japan) on MRA of coronaries and by Daniel Berman (Cedars Sinai Medical Center, USA) on CT of coronaries. There was consensus that the late enhancement technique is by far the best method of diagnosing myocarditis, and seems to be a favorite of all cardiologists. There was also agreement that coronary MRI and angiography is where more research effort is required as this still lags behind what CT can do in this area. If MR of coronaries could match the diagnostic capabilities of CT, then MR would be a onestop shop for clinical cardiac assessment.
Open Access to Products of Health Research The Canadian Institutes of Health Research (CIHR) is developing an ‘open access’ policy. CIHR is initiating a process to develop a research policy that will promote access to the knowledge and resources generated from CIHR-funded research. Currently, CIHR encourages recipients of research support to make the results of all research publicly available. CIHR’s aim is to establish a policy that will both help researchers gain access to the products of research and support CIHR's efforts in facilitating the translation and use of knowledge, while taking into account ethical and legal considerations. Furthermore, as a recipient of public funds there is an obligation to Canadians to ensure that the results and products of research supported by CIHR are disseminated as widely as possible so that all parties benefit from these research outcomes.21
MedEffect: Canada Offers Database of Adverse Drug Reactions This database can be used to access information concerning suspected adverse reactions to Canadian marketed health products of pharmaceuticals, biologics (including blood products and therapeutic and diagnostic vaccines), natural health products, and radiopharmaceuticals, as reported to Health Canada through voluntary and mandatory reporting measures. Information on this website includes data submitted from 1965 to June 2005.22
ACKNOWLEDGEMENTS The author would like to thank Dr. Britton Chance for his many gracious remarks and encouragement years ago as it’s also my honour to have Dr. Chance23 (biography in the Appendix) as my University of British Columbia PhD thesis external examiner, as well as the entire NRC-IBD team and RRC MRI/S Program graduates for providing much of the information for this update, Renee Lien and Anthony Lee for proofreading the manuscript.
APPENDIX Dunnick, Feldman, and Chance named 2006 ARRS Gold Medalists The ARRS has announced the recipients of the 2006 Gold Medal for Distinguished Service. They are N. Reed Dunnick, MD, of the University of Michigan in Ann Arbor; Frieda Feldman, MD, of the Columbia University College of Physicians and Surgeons in New York; and Britton Chance, PhD, MD (Hon), of the University of Pennsylvania in Philadelphia. The ARRS Gold Medal is the society’s highest honor. The awards will be presented during the 2006 ARRS Annual Meeting in Vancouver, BC, Canada on May 3.12 Dr. Britton Chance Dr. Chance is Eldridge Reeves Johnson University Professor Emeritus of Biophysics, Physical Chemistry, and Radiologic Physics at the University of Pennsylvania. He received his Ph.D. from the University of Pennsylvania and his D.Sc. from Cambridge University. He has a multitude of scientific and engineering accomplishments to his name, ranging from the development of the stopped-flow method for observing rapid biological reactions to pioneering research into cell bioenergetics, including the formation of enzymesubstrate compounds.24-25 Dr. Chance and colleagues obtained the first nuclear magnetic resonance (NMR) spectra from excised and in situ heart, brain and liver in 1977-1978, and the first NMR spectra from exercised human limb in 1980. His lifetime contributions to the field of NMR were recognized in 2005 when Dr. Chance delivered the Lauterbur endowed lecture at the annual meeting of the International Society for Magnetic Resonance in Medicine. He has received more than 50 awards and honors, including the National Medal of Science, the College of Physicians Gold Medal for Distinguished Service to Medicine and the National Institutes of Health Christopher Columbus Discovery Award in Biomedical Research. Dr. Chance is the father of the field of optical imaging. His current research interests include cancer detection, cognitive imaging, skeletal muscle function, cardiac myopathy and cancer heterogeneity.26 In 2005, Dr. Chance and colleagues published the results of a six-year, two-population study of a handheld, noninvasive breast cancer detector using near infrared technology that achieved a sensitivity/specificity (ROC) of 94.6%. Dr. Chance has published more than 1,400 refereed papers and given more than 750 conference presentations. He holds 10 honorary degrees, including an MD from the Karolinska Institutet (home of the Nobel Prize Committee for Physiology or Medicine). He is founder and president of Non-Invasive Technology, Inc. Dr. Chance’s avocation is sailing. Even when he was just a teenager, he invented an autosteering device that detected deviations in a ship's course and generated a feedback signal to redirect the ship's steering mechanisms. He has won numerous championships, including the Olympic Gold Medal at Helsinki in 1952, as a member of the U.S. yacht Olympic team.
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at:
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