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3S EXPO X1 BOOTH 501 Complete 3D spine analysis Fits seamlessly in any X-ray Room No additional dose 3D SPINE RECONSTRUCTION C M J CM MJ CJ CMJ N Biomod2.pdf 1 16/02/2016 15:04:50 www.healthcare-in-europe.com 29 EH @ ECR FIRST: A Model-Based Iterative Reconstruction (MBIR) automatically lowers patient exposure up to 80% in clinical routine The notable progress of Maltese radiology Ultra-low dose delivers diagnostic quality Small country takes a big leap The first thing to know about FIRST is how easy it is to use. For clinicians the system makes ultra-low-dose iter- ative reconstruction simple, an auto- mated process that fits seamlessly into daily workflow, Toshiba reports. ‘For radiologists who want to look under the hood and study the engine driving this technological break- through, fast will be the first word that comes to mind. Toshiba acceler- ated computational throughput to bring their true iterative reconstruc- tion technique FIRST to the clinic for which extensive reconstruction times are not acceptable.’ Available for the Aquilion ONE Family of CT systems, FIRST – Forward projection model-based Iterative Reconstruction SoluTion – visually improves high-contrast spa- tial resolution while making exams safer for patients by providing ultra- low dose examinations, Toshiba explains. Professor Alain Blum MD, from the University Hospital of Nancy, in France, scanned over 250 patients with the system in the first week Specialist radiologist Dr Warren Scicluna, at the Medical Imaging Department, Mater Dei Hospital, shares his experience as a radiolo- gist trained in Malta where he cur- rently practices. Up to just a few years ago, he notes, all the country’s radiologists worked as general diag- nostic radiologists and relied on conventional imaging, such as plain radiography, ultrasound, mammog- raphy, computed tomography (CT) and magnetic resonance imaging (MRI). He explains that with regards to interventional procedures only a few were provided by the Medical Imaging Department at Mater Dei Hospital. These, to mention a few, included image-guided drainages, image-guided biopsies, percutane- ous nephrolithotripsy, peripheral angiography and angioplasty. As a result, patients necessitating more specialised radiological techniques after installation and was impressed by the speed and image quality. According to Blum it contributes to or investigations, had to be sent abroad, or would be reviewed by a visiting consultant. ‘This obviously placed an extra financial load on departmental resources.’ he points out. In 2008, just four years after Malta joined the European Union, a post- graduate Radiology training pro- gramme was set up. The training curriculum is largely based on the UK Royal College of Radiologists training curriculum. Trainees spend five years in training, at least one year of which needs to include sub-specialty training in a centre of excellence abroad. A Certificate of Completion (CCT) is awarded to trainees who have completed five years in-training, have successfully passed their annual review of com- a significant improvement in image detail and it was possible to reduce dose to levels he never saw before. petency progression (ARCP), passed the final FRCR examination and spent a year of subspecialty training abroad. So far, seven residents have suc- cessfully finished training and have been awarded CCT. Five trainees are about to embark on subspecialty fel- lowship abroad. Six other trainees are currently undertaking pre-FRCR general radiology training rotations at the Medical Imaging Department in Mater Dei Hospital. Dr Scicluna recalls how, when he himself was a trainee, he and his fellow trainees were encouraged to choose different specialties so as to widen the local diagnostic and inter- ventional scenario. ‘Today, we have a wide range of specialties, including uroradiology, neuroradiology, inter- ventional oncology, gastrointestinal, breast, paediatric and cardiac imag- ing, and,’ he adds: ‘this was sup- plemented by the addition of new equipment, such as a 3-Tesla MRI scanner, new mammography and ultrasound machines, while a new angiography suite and a 256-slice CT scanner are also in the pipeline. ‘In the meantime, the specialists were also provided with new devic- es, such as wires, stents, microwave and radiofrequency ablation devices, an insufflator for CT colonoscopy, ultrasound contrast, embolisation spheres with and without drug load- ing, to mention a few.’ The new services available in every radiology sub-specialty in Malta are various. In the case of uroradiology, Dr Scicluna’s own specialty, these include MRI of the prostate for local staging and diag- nostic purposes, targeted transrectal ultrasound prostate biopsy, MRI of ‘With the new algorithm we can reduce the dose by a factor three compared to currently state of the art the penis for staging or imaging of Peyronies’ disease, transrectal ultra- sound to assess infertility amongst other conditions and ultrasound Doppler of the penis for erectile dysfunction. The Neuroradiology section now offers a 24-hour on-call service for mechanical thrombolysis, carotid stenting services and meningioma embolisation, whilst the radiologists working in interventional oncology have introduced microwave abla- tion of liver, renal, pulmonary and pancreatic lesions and transcatheter arterial chemo-embolisation (TACE). Gastrointestinal imaging services include CT colonography and CT/ MR enterography, while breast imag- ing now provides triple assessment and stereotactic biopsy and vacu- um-assisted core biopsy are to be introduced soon. Cardiac CT and MR have also been recently added to the repertoire. Although certain specialised techniques, such as coil- iterative reconstructions, this is very impressive,’ he said. ‘The new system is integrated in SUREExposure, Toshiba’s AEC tool, to ensure automatic dose reduc- tion of up to 80% in volume and helical scanning respecting the user- required clinical image quality. Using dedicated hardware the reconstruc- tion of a complex volumetric data set only takes approximately three minutes,’ the manufacturer reports. Blum: ‘We see an improved image quality with fast reconstruction that’s easy to use, even at two o’clock in the morning. What we also see with FIRST is an opportunity for new protocols and applications, such as ultra low dose chest CT exams for pulmonary embolism with frail patients who have renal or cardiac insufficiency, for pregnant women or patients in a coma.’ Henk de Vries, Senior Product Manager at Toshiba Medical Systems: ‘Quite simply our approach is that advanced iterative reconstruction should not be a technological chal- lenge, but an automated technology that fits seamlessly into daily clinical practice. FIRST works with forward projection in the raw data domain using optic models to improve spa- tial resolution; it is incredibly robust for data with extremely low photon counts and improves image quality. The automated process translates into an easy and fast application to significantly reduce the radiation and improve image quality.’ ing of aneurysms and transjugular intrahepatic porto-systemic shunts do not form part of the currently available local services, possibly due to the small number of patients needing such interventions, Dr Scicluna insists that, despite its lim- ited resources, the local healthcare system can still boast of a state of the art Medical Imaging Department. ‘We’ve come a long way in less than a decade, starting off with the most basic of expertise, to the diversity and wealth of experience we enjoy today, mostly by changing the way we utilise our resources,’ he states with pride. This was indeed a big leap from the ‘small island mentality’ of the past, where limitations shaped the perspective of both the individual professional and the healthcare sys- tem at large. It only took one small shift to change the department for the better and irrevocably. FIRST, with forward projection in the raw-data domain and using optical models visually improves spatial and low contrast resolution while making exams safer for patients by automatically providing integrated ultra-low dose settings to enhance clinical routine. Living in a small Mediterranean island has its own advantages; nevertheless there are certain limitations. In healthcare, for example, resources may be somewhat more limited in such a small country and some of the latest technologies may not always be available to patients. Moira Mizzi reports At work: specialist radiologist Dr Warren Scicluna at the Medical Imaging Department of Mater Dei Hospital Biomod2.pdf 116/02/201615:04:50

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