Download RSNA 2010shortsummary

Some Highlights of RSNA 2010
Theme & Plenaries
Theme = “Personalised medicine”, ie designing investigation and
management around the individual, taking into account both genetic and
phenotypic factors, and using specifically targeted interventions – the target often
being molecular.
President’s Address (Hedy Hricak) : Cancer rx now in era of molecular
targeting, needs targeted imaging to guide choice and assess effectiveness.
More specific targeting -> more sensitive results, need to design appropriate
probes. Example of prostate bone metastases with plain radiograph, CT, Tc
bone scan, FDG-PET and now a fluorinated androgen receptor label (F-DHT) –
with successively more and better resolved lesions. Better targeted treatments
making cancer a chronic disease. Better tools and treatments also reveal more
complexity – over 100 different tyrosine kinases now identified (since 1980),
subtypes of ‘common’ disease, heterogeneity within a ‘single’ process – eg dedifferentiation of metastases in comparison with their ‘parent’ primary ; 30 % lose
the primary’s biomarkers.
Christian Herold – Lung nodules, characterization and measurement for
individualized management. Pending Fleischner Society guidelines for sub-solid
nodules. Broncho-alveolar ca (doubling time 1 – 1.5 years) vs adenoca vs
atypical adenomatous hyperplasia (doubling time 3 years)
Sanjay Gambhir – [Far] too much money spent in last year of life on late stage
disease, need to develop predictive, preventive, and early interventional
measures ( was conceded that anti-smoking campaigns are the most effective of
these to date).
Lab of 200 pursuing genetic prediction, imaging to find the predicted lump and
biopsy +/- treat it (“theranostics”) – targeted drug delivery (needle or, more likely,
targeted molecular carrier). Major project in ovarian cancer screening (previous
strategies having failed). High-resolution laser photo-acoustic technique for
optical imaging.
Gawande - not attended. Emphasis reported to be on need for quality, role of
simple measures like checklists
Clinton – not attended – Reportedly not very imaging specific, attention to need
for better cancer rx in poor countries (Clinton foundation already addressing HIV
in poor countries)
Big News
Whole-body combined PET-MRI Siemens Biograph mMR 3T MRI system
(substantially modified Skyra [current model], specially designed coils, gradients
(45/200), bore 60 cm ; APD detectors in bore, amplifiers and cables (lots of
copper) at far end of bore. First installation, in operation 13 days, in Munich,
seems to have mostly done post-treatment oncology follow-ups. Measured SUVs
said to be comparable to those at ‘corresponding’ PET-CT Will be mainly
targeted at brain work. Spectroscopic capabilities (esp multinuclear) unclear.
Attenuation correction based on Dixon water-fat separation.
Phase 1 human trial of hyperpolarised 13C MR spectroscopy just
commenced at UCSF (Kurhanewicz) – 4 pts so far – 13C pyruvate in prostate ca.
Spectral Q & resolution at starting dose promising. The original Hypersense
hyperpolariser seems to have been further modified and miniaturized, and now
lives in the scan room (good for rapid delivery). See ‘science’ below for
additional details
Digital Breast Tomosynthesis Likely to receive US FDA approval in Feb 2011
(already approved in parts of Europe). Many more images (cf full-field digital);
does improve sensitivity to masses, now not bad for calcifications. Interpretation
time longer. Eventual role unclear, likely for tough cases at first.
Some attention to Breast-Specific Gamma Imaging (BSGI ; ie, sestamibi with
dedicated camera) and Positron Emission Mammography (PEM).
Ultrasound Elastography - Not FDA approved, but being used in several US
places (as well as Europe) Possible roles in diffuse and focal liver disease,
breast masses, inter alia.
RSNA Image sharing project Demonstrated in trade exhibition, to go live in
02/2011 – 5 academic medical centres, RSNA, image clearinghouse and 3 (or 4
?) personal health record vendors.
RSNA Image Wisely project launched – encouraging dose reduction, a la
Image Gently for paediatrics.
Informatics
Over the last several years the RSNA has developed an impressive array of
informatics projects to support radiology in the digital era; these include Radlex,
MIRC/CTP, and its contribution to IHE. Detailed summary of these will follow in
the next day or two.
Vendors
All showed versions of CT / US image fusion to guide biopsy
GE
Combined PET-CT/ MRI (WIP) table located between the CT and MRI gantries.
“Molecular Breast Imaging” –sestamibi SPECT (CZT detectors), Discovery
NM750b, due Q2 2011
New (WIP) 3T MRI, Discovery MR750w - 45/200 gradients, “Multidrive” multitransmit RF, 70 cm bore, 3D ASL, MR Touch elastography, Propeller v3.0
Also modified Oni extremity system, 1.5 T, 70/300 gradients (WIP)
New iterative reconstruction ( Model-based IR, MBIR) for dose reduction (p to 80
%), in CT ‘Veo’ – massive reconstruction tasks, taking up to 30 min
Hand-held ultrasound system
Philips
Co-located PET and MRI system (patient shuttles between (not seen)).
New (WIP, ? appro 12/2010) Ingenia 3T MRI, fibreoptic cabling from detectors to
improve SNR (“40 %”), multi-transmit, 128 channels ; 200 cm flexible coil for WB
imaging
Ingenuity CT with iDose 4 iterative recon dose reduction
Keen to push new version of iSite PACS and Imtellispace thin-client portal for
web access (incl some 3D processing)
Siemens
Mock-up of, and images from, the prototype MRI-PET site in Zurich – Biograph
mMR, operational less than 2 weeks ; WIP, may be available in Europe 2H 2011,
USA ? 2012.
Biograph mCT 20 Excel PET-CT, 20 slice CT
Minor changes to Skyra 3T with “Tim 4D” (able to scan table in motion,
analogous to CT), and DOT (throughput enhancement). New coils & plugs –
body matrix coils now look pretty much like anyone else’s body coils. Fully
detachable table.
Further improvements to iterative reconstruction in CT, for dose reduction –
‘Safire’ CT, supposedly 72 % cases done with dose < 2 mSv (~ annual
background)..
US elastography as product, ‘Virtual Touch’ (not FDA). Reportedly stereoscopic
presentation (with 3D glasses) – not personally seen
Tomosynthesis product (not yet FDA).