Evolving and experimental technologies in medical imaging

Evolution from Medical Imaging to Visualized Medicine

The discovery of X-ray in 1895 and the first X-ray image of Mrs. Röntgen's hand opened up a new era of radiology and the research of medical imaging. The evolution of traditional medical imaging has been lasting for over 100 years, serving the detection, diagnosis, and treatments of human diseases with a clear view of the anatomy information. In late 1990s, the concept of molecular imaging was proposed as the science and technology of molecular biology and bio-engineering rapidly developed, and it directly gave birth to the emergence of precision medicine for clinical lesion-targeted treatments against various cancers and cardiocerebrovascular diseases. Physiological and pathological changes in live bodies from zebrafish to human beings can be imaged to ensure an efficient image-guided therapy. Nowadays, the philosophy of medical and molecular imaging has been a powerful tool and indispensable modality for doctors to make their decisions and give patients reliable advices. With the ever-emerging developments of advanced intelligent technologies such as flexible sensors, medical meta-data analysis, brain sciences, surgical robots, VR/AR, etc., modern medicine has been evolving from traditional medical and molecular imaging to visualized medicine, which has created novel accessible approaches along with cutting-edge techniques for the revolutionized diagnostic and therapeutic paradigms. In this context, the history and milestones from medical imaging to visualized medicine will be elucidated. And in particular, representative visualized medicine advances including its application to COVID-19 epidemics will be discussed in order to look for its important contributions and a future perspective to modern medicine.

Thousand shades of gray - The role of imaging display in diagnosis of occult scaphoid fractures - A pilot study

Introduction

Most hospitals and clinics utilize commercial grade displays for viewing wrist radiographs. There is no evidence regarding the role of the imaging display used to evaluate the radiographs. The aim of this study was to compare the rates of scaphoid fracture diagnosis by commercial grade and medical grade displays.

Methods

Wrist radiographs of patients that had clinical signs of scaphoid fracture without findings on plain radiography (suspected scaphoid fractures) were retrospectively collected from ER department and interpreted for radiographic signs of fracture by four orthopedics seniors commercial grade and medical grade displays. The difference in fracture diagnosis rates were studied. Inter- and intra-observer variability were also studied.

Results

Study population comprised of 175 high quality wrist radiographs were interpreted. Mean 48.25 (27%) scaphoid fractures were observed on commercial grade display compared to 66 (38.2%) on medical grade display (p = 0.076). The total inter-observer agreement could be defined as a moderate agreement (κ = 0.527, Accuracy = 0.77). Total agreement between all observers were observed in 86 (49.1%) cases compared to 89 (50.9%) cases when reviewing X-rays on commercial and medical displays, respectively.

Discussion

The scaphoid fracture detection rate on medical grade display was not statistically higher compared to non-medical grade displays, but we did find a tendency toward medical grade display. We found that in a substantial number of cases, our observers recognize signs of fracture that were initially evaluated as "suspected fracture" by the ER physicians. As a pilot study, we found evidence that support the need for a prospective study designed to compare the observations to a gold standard modality, such as MRI. We believe utilizing medical grade displays can increase the rate of diagnosis in cases of clinically suspected scaphoid fractures and better manage the clinical scenario of a suspected scaphoid fracture.

0.1 THz exposure affects primary hippocampus neuron gene expression via alternating transcription factor binding

In recent years, many studies have been conducted to investigate the influence of terahertz (THz) radiation on the gene expression in various cell types, but the underling molecular mechanism has not yet been fully revealed. In this study, we explored the effects of 0.1 THz radiation on the gene expression in primary neuron cells through RNA-seq analysis. 111 up-regulated and 54 down-regulated genes were identified. Several biomolecule binding related categories such as "long-chain fatty acid binding", "tropomyosin binding", "BMP receptor binding", as well as "GTPase binding" and "phospholipid binding" were enriched by GO analysis. Moreover, the GSEA analysis indicated that genes encoding protein biosynthetic machinery ribosome were up-regulated by 0.1 THz irradiation. In addition, we demonstrated that the binding efficiency of a transcription factor (TF) AP-1 with its transcription factor binding site (TFBS) in DNA was reduced by THz irradiation, which suggested that THz irradiation might affect the interaction between TFs with DNA and consequently regulate the gene expression. Our results provide new insights into the biological effects of terahertz irradiation.

Vector projectile imaging: time-resolved dynamic visualization of complex flow patterns

Achieving non-invasive, accurate and time-resolved imaging of vascular flow with spatiotemporal fluctuations is well acknowledged to be an ongoing challenge. In this article, we present a new ultrasound-based framework called vector projectile imaging (VPI) that can dynamically render complex flow patterns over an imaging view at millisecond time resolution. VPI is founded on three principles: (i) high-frame-rate broad-view data acquisition (based on steered plane wave firings); (ii) flow vector estimation derived from multi-angle Doppler analysis (coupled with data regularization and least-squares fitting); (iii) dynamic visualization of color-encoded vector projectiles (with flow speckles displayed as adjunct). Calibration results indicated that by using three transmit angles and three receive angles (-10°, 0°, +10° for both), VPI can consistently compute flow vectors in a multi-vessel phantom with three tubes positioned at different depths (1.5, 4, 6 cm), oriented at different angles (-10°, 0°, +10°) and of different sizes (dilated diameter: 2.2, 4.4 and 6.3 mm; steady flow rate: 2.5 mL/s). The practical merit of VPI was further illustrated through an anthropomorphic flow phantom investigation that considered both healthy and stenosed carotid bifurcation geometries. For the healthy bifurcation with 1.2-Hz carotid flow pulses, VPI was able to render multi-directional and spatiotemporally varying flow patterns (using a nominal frame rate of 416 fps or 2.4-ms time resolution). In the case of stenosed bifurcations (50% eccentric narrowing), VPI enabled dynamic visualization of flow jet and recirculation zones. These findings suggest that VPI holds promise as a new tool for complex flow analysis.

Nanotechnology-supported THz medical imaging

Over the last few decades, the achievements and progress in the field of medical imaging have dramatically enhanced the early detection and treatment of many pathological conditions. The development of new imaging modalities, especially non-ionising ones, which will improve prognosis, is of crucial importance. A number of novel imaging modalities have been developed but they are still in the initial stages of development and serious drawbacks obstruct them from offering their benefits to the medical field. In the 21 (st) century, it is believed that nanotechnology will highly influence our everyday life and dramatically change the world of medicine, including medical imaging. Here we discuss how nanotechnology, which is still in its infancy, can improve Terahertz (THz) imaging, an emerging imaging modality, and how it may find its way into real clinical applications. THz imaging is characterised by the use of non-ionising radiation and although it has the potential to be used in many biomedical fields, it remains in the field of basic research. An extensive review of the recent available literature shows how the current state of this emerging imaging modality can be transformed by nanotechnology. Innovative scientific concepts that use nanotechnology-based techniques to overcome some of the limitations of the use of THz imaging are discussed. We review a number of drawbacks, such as a low contrast mechanism, poor source performance and bulky THz systems, which characterise present THz medical imaging and suggest how they can be overcome through nanotechnology. Better resolution and higher detection sensitivity can also be achieved using nanotechnology techniques.

Frequency-domain intravascular optical coherence tomography of the femoropopliteal artery

PURPOSE

Optical coherence tomography (OCT) is a catheter-based imaging method that employs near-infrared light to produce high-resolution intravascular images. The authors report the safety and feasibility and illustrate common imaging findings of frequency-domain OCT (FD-OCT) imaging of the femoropopliteal artery in a series of 20 patients who underwent infrainguinal angioplasty.

METHODS

After crossing the lesion of interest, OCT was performed with a dextrose saline flush technique with simultaneous obstructive manual groin compression. An automatic pullback FD-OCT device was employed (each scan acquiring 54 mm of vessel lumen in 271 consecutive frames). OCT images were acquired before and after balloon dilatation and following provisional stenting if necessary and were evaluated for baseline characteristics of plaque or in-stent restenosis (ISR), vessel wall trauma after angioplasty, presence of thrombus, stent apposition, and tissue prolapse. Imaging follow-up was not included in this study's protocol.

RESULTS

Twenty-seven obstructive lesions (18 cases of de novo atherosclerosis and 9 of ISR) of the femoropopliteal artery were imaged and 148 acquisitions were analyzed in total. High-resolution intravascular OCT imaging with effective blood clearance was achieved in 93.9%. Failure was mainly attributed to preocclusive proximal lesions and/or collateral flow. Mixed features of lipid pool areas, calcium deposits, necrotic core, and fibrosis were identified in all of the imaged atherosclerotic lesions, whereas ISR was purely fibrotic. After balloon angioplasty, OCT identified extensive intimal tears in all cases and one case of severe dissection that biplane subtraction angiography failed to identify.

CONCLUSIONS

Infrainguinal frequency-domain optical coherence tomography is safe and feasible and may provide intravascular high-resolution imaging of the femoropopliteal artery during infrainguinal angioplasty procedures.

In vitro investigation of the biological effects associated with human dermal fibroblasts exposed to 2.52 THz radiation

BACKGROUND

Terahertz (THz) radiation sources are increasingly being used in military, defense, and medical applications. However, the biological effects associated with this type of radiation are not well characterized. In this study, we evaluated the cellular and molecular response of human dermal fibroblasts exposed to THz radiation.

METHODS

In vitro exposures were performed in a temperature-controlled chamber using a molecular gas THz laser (2.52 THz, 84.8 mW cm(-2), durations: 5, 10, 20, 40, or 80 minutes). Both computational and empirical dosimetric techniques were conducted using finite-difference time-domain (FDTD) modeling approaches, infrared cameras, and thermocouples. Cellular viability was assessed using conventional MTT assays. In addition, the transcriptional activation of protein and DNA sensing genes were evaluated using qPCR. Comparable analyses were also conducted for hyperthermic and genotoxic positive controls.

RESULTS

We found that cellular temperatures increased by 3°C during all THz exposures. We also found that for each exposure duration tested, the THz and hyperthermic exposure groups exhibited equivalent levels of cell survival (≥90%) and heat shock protein expression (∼3.5-fold increases). In addition, the expression of DNA sensing and repair genes was unchanged in both groups; however, appreciable increases were observed in the genotoxic controls.

CONCLUSIONS

Human dermal fibroblasts exhibit comparable cellular and molecular effects when exposed to THz radiation and hyperthermic stress. These findings suggest that radiation at 2.52 THz generates primarily thermal effects in mammalian cells. Therefore, we conclude that THz-induced bioeffects may be accurately predicted with conventional thermal damage models.

Increased microstructural variability is associated with decreased structural strength but with increased measures of structural ductility in human vertebrae

The lack of accuracy in the prediction of vertebral fracture risk from average density measurements, all external factors being equal, may not just be because bone mineral density (BMD) is less than a perfect surrogate for bone strength but also because strength alone may not be sufficient to fully characterize the structural failure of a vertebra. Apart from bone quantity, the regional variation of cancellous architecture would have a role in governing the mechanical properties of vertebrae. In this study, we estimated various microstructural parameters of the vertebral cancellous centrum based on stereological analysis. An earlier study indicated that within-vertebra variability, measured as the coefficient of variation (COV) of bone volume fraction (BV/TV) or as COV of finite element-estimated apparent modulus (E(FE)) correlated well with vertebral strength. Therefore, as an extension to our earlier study, we investigated (i) whether the relationships of vertebral strength found with COV of BV/TV and COV of E(FE) could be extended to the COV of other microstructural parameters and microcomputed tomography-estimated BMD and (ii) whether COV of microstructural parameters were associated with structural ductility measures. COV-based measures were more strongly associated with vertebral strength and ductility measures than average microstructural measures. Moreover, our results support a hypothesis that decreased microstructural variability, while associated with increased strength, may result in decreased structural toughness and ductility. The current findings suggest that variability-based measures could provide an improvement, as a supplement to clinical BMD, in screening for fracture risk through an improved prediction of bone strength and ductility. Further understanding of the biological mechanisms underlying microstructural variability may help develop new treatment strategies for improved structural ductility.

Adoption and spread of new imaging technology: a case study

Technology is a major driver of health care costs. Hospitals are rapidly acquiring one new technology in particular: 64-slice computed tomography (CT), which can be used to image coronary arteries in search of blockages. We propose that it is more likely to be adopted by hospitals that treat cardiac patients, function in competitive markets, are reimbursed for the procedure, and have favorable operating margins. We find that early adoption is related to cardiac patient volume but also to operating margins. The paucity of evidence informing this technology's role in cardiac care suggests that its adoption by cardiac-oriented hospitals is premature. Further, adoption motivated by operating margins reinforces concerns about haphazard technology acquisition.

Breast cancer imaging: a perspective for the next decade

Breast imaging is largely indicated for detection, diagnosis, and clinical management of breast cancer and for evaluation of the integrity of breast implants. In this work, a prospective view of techniques for breast cancer detection and diagnosis is provided based on an assessment of current trends. The potential role of emerging techniques that are under various stages of research and development is also addressed. It appears that the primary imaging tool for breast cancer screening in the next decade will be high-resolution, high-contrast, anatomical x-ray imaging with or without depth information. MRI and ultrasonography will have an increasingly important adjunctive role for imaging high-risk patients and women with dense breasts. Pilot studies with dedicated breast CT have demonstrated high-resolution three-dimensional imaging capabilities, but several technological barriers must be overcome before clinical adoption. Radionuclide based imaging techniques and x-ray imaging with intravenously injected contrast offer substantial potential as a diagnostic tools and for evaluation of suspicious lesions. Developing optical and electromagnetic imaging techniques hold significant potential for physiologic information and they are likely to be of most value when integrated with or adjunctively used with techniques that provide anatomic information. Experimental studies with breast specimens suggest that phase-sensitive x-ray imaging techniques can provide edge enhancement and contrast improvement but more research is needed to evaluate their potential role in clinical breast imaging. From the technological perspective, in addition to improvements within each modality, there is likely to be a trend towards multi-modality systems that combine anatomic with physiologic information. We are also likely to transition from a standardized screening, where all women undergo the same imaging exam (mammography), to selection of a screening modality or modalities based an individual-risk or other classification.

Time-course of contrast enhancement in spleen and liver with Exia 160, Fenestra LC, and VC

OBJECTIVE

The purpose of this study was to compare the time-course of contrast-enhancement in spleen and liver using Exia 160 in comparison with Fenestra LC and VC in healthy mice.

PROCEDURES

Healthy C57bl/6 mice were used in this study. Fenestra LC and VC was administered intravenously at a dose of 0.1 ml/20 g or 0.2 ml/20 g. Exia 160 at a dose of 0.05 ml/20 g or 0.1 ml/20 g. Each animal underwent a micro-CT scan before contrast injection (baseline) and immediately after contrast injection. Additional scans were performed at 1, 2, 3, 4, 24, and 48 h after contrast administration. The mice who received Exia 160 were also scanned after 15, 30, and 45 min.

RESULTS

The peak enhancement of Exia 160 occurred after 15 min for the spleen and after 30 min for the liver.

CONCLUSIONS

Exia 160 allows rapid spleen and liver enhancement. The high iodine content results in small injection volumes.

Modern imaging of the hand, wrist, and forearm

A review of the current state of the relevant diagnostic imaging technologies and methods and their clinical application in imaging common conditions of the hand, wrist, and forearm is presented. Evolving and future imaging technologies are also considered.

The National Institute of Biomedical Imaging and Bioengineering and NIH Grant Process: An Overview

The National Institutes of Health (NIH) comprise the largest single source of funding in the world for the support of biomedical research. Much of the work of the NIH focuses on the elucidation of fundamental biophysical, biochemical, and biologic aspects of the molecular, cellular, and tissue processes underlying both healthy and diseased states of biologic systems and on the development of cures for the latter. In 2000, the National Institute of Biomedical Imaging and Bioengineering (NIBIB) was created with a somewhat different focus: Rather than concentration on a specific organ system or category of disease, the primary objective of the NIBIB is the advancement of technologies and tools that contribute to all aspects of biomedical research and health care delivery, especially in the imaging sciences and bioengineering. This article provides an overview of the ways in which NIH funds research, with an emphasis on NIBIB support of biomedical imaging. It is intended for radiologists, radiation oncologists, medical physicists, and other readers of this journal, especially those with limited experience in the complex process of obtaining NIH grant support.

Neuro-oncological applications of optical spectroscopy

Advances in optics and molecular imaging have occurred rapidly in the past decade. One technique poised to take advantage of these developments is optical spectroscopy (OS). All optical spectroscopic techniques have in common tissue interrogation with light sources ranging from the ultraviolet (UV) to the infrared (IR) ranges of the spectrum, and collection of information on light reflected (reflectance spectroscopy) or light interactions with tissue and emergence at different wavelengths (fluorescence and Raman spectroscopy). OS can provide information regarding intrinsic tissue optical properties such as tissue structure, nuclear density, and the presence or absence of endogenous or exogenous fluorophores. Among other applications, this information has been used to distinguish tumor from normal brain tissues, to detect tumor margins in intrinsic, infiltrating gliomas, to identify radiation damage to tissues, and to assess tissue viability and predict the onset of apoptosis in vitro and in vivo. Potential applications of OS include detection of specific central nervous system (CNS) structures, such as brain nuclei, identification of cell types by the presence of specific neurotransmitters, and the detection of optically labeled cells or drugs during therapeutic interventions. All have potential utility in neuro-oncology, have been investigated in our laboratories, and will be the subject of this review.

Government reform of the National Health Service: implications for radiologists and diagnostic services

Demand for radiology services within the National Health Service (NHS) continues unabated and current NHS operations cannot keep up with demand. Therefore, to meet this demand, the government has decided to outsource a significant number of investigations to the independent sector and will actively promote patient referrals to the new government sponsored Treatment Centres as they become available. This presents opportunities to patients, but threatens existing public sector providers (including doctors) as competition for radiology services may result in both loss of patient referrals and revenue to these providers. This article is a personal opinion and will focus on the current challenges facing the provision of radiology services in the NHS. I will suggest the possible negative outcomes for providers (NHS hospitals and staff alike) and will offer strategies, tactics and tools that can be employed to counter the threat to their existing services.