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RSNA Daily Dispatch – A New Focus on Machine Learning

For the first time ever, the technical exhibits halls at the RSNA Annual Meeting include a machine learning showcase, where a variety of researchers and industry ventures have the opportunity to share cutting edge work in artificial intelligence and deep learning in healthcare and radiology.

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One company collected 9 million radiology data sets over three years to train computers to automatically recognize and diagnose a wide range of injuries and pathologies. Other research involved using parameters of patients’ demographic information and medical history records  to predict a prognosis. From managing massive amounts of patient data to quickly assessing complex medical images, machine learning can assist radiologists in their current tasks and allow for a level of planning and diagnosis that would not be possible without the trove of information stored in big data.

RSNA Daily Dispatch

The Monday, Nov. 27 schedule of the 2017 RSNA Annual Meeting included a variety of scientific sessions discussing technical and clinical developments in Cone Beam CT systems. From improving image quality to correlating with other modalities, researchers are validating the efficacy of CBCT in diagnosis and treatment of musculoskeletal injuries and pathologies.

@Ingakoerte tweeted a photo of the crowds at the RSNA Annual Meeting.
@Ingakoerte tweeted a photo of the crowds at the RSNA Annual Meeting.

In a poster presentation for “High Resolution Extremity Cone-Beam CT with a CMOS X-Ray Detector: System Design and Applications in Quantitative Assessment of Bone Health” Biomedical Engineer Qian Cao evaluated the ideal Cesium Iodide scintillator thickness to visualize trabecular bone detail for applications such as early detection of osteoarthritis. He compared image quality characteristics of an optimized CMOS detector to an amorphous silicon detector and a micro CT scanner. The optimized CMOS detector had superior trabecular detail compared to the Amorphous Silicon detector and comparable detail to the Micro-CT, with the advantage of a much larger field of view than Micro-CT.

In “Effect of Motion Compensation on the Image Quality of Cone Beam CT Scans in Musculoskeletal Setting” Guarav K. Thawait, MD, research associate at Johns Hopkins shared the results of a study where involuntary patient motion in CBCT scans was corrected using an iterative reconstruction algorithm. The algorithm improved motion artefacts significantly in bone structures.

In “Evaluation of Bone Erosions in Rheumatoid Arthritis Patients using CBCT and MRI,” Dr. Thawait discussed a study in which a radiologist reviewed CBCT, MRI, and Ultrasound datasets for signs of rheumatoid arthritis. The correlation between CBCT and MRI was moderate while the correlation between CBCT and US was a bit higher. Though the correlations were only moderate to good between modalities, test-retest reproducibility for CBCT scans was excellent and the modality shows promise as a useful tool for RA diagnostic evaluation.

RSNA Daily Dispatch

The Radiological Society of North America (RSNA) commenced its 103rd Annual Meeting in Chicago on Sunday, Nov. 26, 2017.

@judywawira tweeted a photo of  a standing room only session at the RSNA Annual Meeting on Nov. 26, 2017.
@judywawira tweeted a photo of a standing room only session at the RSNA Annual Meeting on Nov. 26, 2017.

Attendees from around the world gathered to learn about the latest advances in imaging.

In an afternoon session titled “Open Gantry Systems: Advances, Challenges, and New Applications,” Dr. Jeffrey H. Siewerdsen, PhD, of Johns Hopkins Biomedical Engineering, discussed the vast applications of cone beam CT for interventional and diagnostic imaging. The devices presented included C-arms for image guided surgery, Cone Beam CT guided radiation therapy systems, and diagnostic imaging devices for breasts, dental/ENT, and orthopedic extremities.  Siewerdsen emphasized the  revolutionary potential of weight-bearing extremity devices in orthopedic specialties, and mentioned the CurveBeam pedCAT and LineUP systems.  He also discussed the image quality parameters of Cone Beam CT and artifacts specific to this type of imaging. He offered suggestions on how to quantify image performance of such systems, many of which are relatively new and do not have established quality metrics in the imaging community. Finally, he presented some of the newest Cone Beam CT devices to come to market, including the extremely compact CurveBeam InReach made primarily for hand and wrist imaging.

Department of Energy Considers Radiation Research Funding

Radiation has a bad reputation, especially among lay people, but even in the medical community to a degree. Radiation is in the air we breathe, the food we eat, the water we drink, and even in our own inner biological workings. The dangers of radiation exposure are real—high levels of radiation exposure have been shown to have a clear link to cancer in repeated reputable studies—but not all levels of radiation are known to increase cancer risks, or at the very least, not all levels of radiation are alike.

Medical professionals agree that radiation at appropriate levels has done a great deal of good in our world. Its usefulness in diagnostic medicine has reduced the need for surgeries and other invasive procedures and it has saved millions of lives. The medical establishment is now beginning to question if avoiding radiation when possible is the best approach for the best outcomes.

Medical professionals specializing in radiology and oncology have been pushing in recent years for further study on the effects of low doses of radiation for positive medical purposes. Previous research has focused on radiation at higher doses, such as situations in which individuals have survived nuclear warfare or live near radioactive sites. Studies regarding medical usage of radiation primarily has been concerned with higher doses as well, like those used in the treatment of cancer. Unfortunately, however, very little is known about smaller doses and its risks versus its benefits. So, the medical community is lobbying hard to acquire funding for this type of research.

On November 1, 2017, a meeting was held in which presentations were made before the Committee on Science, Space, and Technology: Subcommittee on Energy regarding the urgent need for funding from the U.S. Department of Energy for Basic Research on Low Dose Radiation. Among those in attendance was James A. Brink, MD, FACR. Dr. Brink is the Radiologist-in-Chief at Massachusetts General Hospital and the Juan M. Taveras Professor of Radiology at Harvard Medical School. Dr. Brink is also the Chair of the Board of Chancellors for the American College of Radiology (ACR). He and others spoke to the subcommittee regarding the importance of research on the effects of low dose radiation.

Dr. Brink and others explained that radiation is used in many items we use in our world today, and in fact occurs naturally in our environment. He also explained to the committee that “the most significant source of exposure to manmade radiation in humans is that associated with medical diagnostic and therapeutic procedures,” such as medical imaging in CT scans, X-rays, and other procedures. While we know the risks of cancer in exposure to high levels of radiation, he argued, there is much less certainty regarding the results of low levels.

Gayle Woloschak, Professor of Radiation Oncology and Radiology at Northwestern University, echoed Brink’s statements. She added that our knowledge about smaller radiation doses is inconsistent. And, as she described, “Contradictory data…make for contradictory assumptions.” Even medical professionals do not agree on how much radiation is too much radiation, so it has been deemed safest to work under the belief that medicine should utilize as little radiation as possible for imaging and similar procedures. Woloschak questioned that belief, and also urged the committee to consider the funding, insisting that “a small change in our knowledge can make for drastic changes in recommended policy.” She added that the highly conservative stance, in which we are “overprotecting” our patients from radiation, could actually be costing funds that could be otherwise used to advance our well-beings in other areas.

Brink, Woloschak, and other experts at the DOE meeting all made similar intriguing arguments for the need for more information regarding the effects of low dose radiation. They all seem to agree that there is a compromising middle ground now in which some medical professionals are adopting the philosophy that it is acceptable, and even advisable, to continue to carefully monitor radiation. However, it is important to think not in terms of lowest dose possible, but instead in terms of the dosage level that is safest and also most therapeutic. The need to determine that “sweet spot” is why funding and research, they argue, is so critical right now.

We at CurveBeam stay on top of trends in medicine and stay abreast of recent medical advances. It is our desire to design products and offer services that help you as physicians find the best possible outcomes for your patients. For more information about our product line, visit us at today!

Works Consulted
ACR Chair Asks Congress for Radiation Research Funds

Pedography Plus PedCAT Clarifies the Relationship Between COG and FC

For those needing to analyze the relationship between morphology-based foot center (FC) and force/pressure-based center of gravity (COG), a study by Martinus Richter, M.D., Ph.D., Francois Lintz, M.D., Stefan Zech, M.D., and Stefan Meissner titled Combination of PedCAT with Pedography Shows Relationship of Morphology (Bone) Based Foot Center (FC) and Force/Pressure Based Center of Gravity (COG) showed that combining pedCAT with pedography fulfills those needs. The pedCAT gives you exact, bilateral, weight-bearing 3-dimentional views of the foot and ankle. By inserting a customized pedography sensor into the PedCAT, a new range of analyses was made possible.

In this study 36 patients/72 feet of patients 18 years of age and older were analyzed using pedCAT/pedography. Feet were scanned in a standing position with full weight-bearing. “The morphology based definition of the FC was performed with the pedCAT data following the TALAS algorithm. This algorithm takes different bony landmarks (Posterior calcaneal process, center of talar dome/tibial plafond, metatarsal heads) into consideration and calculates the FC. The force/pressure based COG was defined with the pedography data using a software based algorithm.”

While there is no relevant movement in the COG during the combined pedCAT/pedography scan, there was a 22.6 mm average distance between COG and FC, and FC was found to be distal to COG in all feet and lateral in 49 feet (68%), with no difference found between right and left feet. In other words, as expected, a difference between FC and COG was discovered using this method. Since there is a standard/typical shift between COG and FC, additional pedography may not be needed to predict COG based on FC.

Curvebeam, founded in 2009 by a group of individuals with a proven track record in the advances and compact 3D imaging device domain, designs and manufacturers imaging equipment for the orthopedic and podiatric specialties. The pedCAT from CurveBeam may be small (4’ x 5’), but it is increasingly being shown through research to make the podiatrist’s job a lot easier and their diagnoses more accurate than ever.

To learn more about the exciting new pedCat from CurveBeam, visit today!

Webinar: Clinical Insights from Dr. Cesar de Cesar Netto

curvebeam webinar

Current research in orthopedics and podiatry have revealed many advantages of weight-bearing CT procedures over traditional ones.

To offer greater insight into Weight Bearing CT benefits, Dr. Cesar de Cesar Netto, of the Hospital for Special Surgery, is offering a lecture via Webcast on Tuesday, November 14. His lecture is titled, “Weight Bearing CT as an Essential Diagnostic Tool in Clinical Practice.”

Dr. Netto explained, “I will be demonstrating cases that would not normally be indicated for a medical CT exam. I will review how those cases presented on X-Ray, and then compare those to weight bearing CT scans of the same patient. I will show how weight bearing CT can often illuminate a pathology or deformity in ways that radiograph can often miss altogether.”

Prior to 2012, doctors and patients had fewer choices for imaging. X-rays can obscure bony detail, and non-weight bearing CTs lack accuracy with regard to join space and alignment. Today’s weight bearing CT scans improve upon the weaknesses of prior imaging options, and can result in a higher level of care for orthopedic and podiatry patients.

To register for this lecture, click here. To watch more webinars, click here.