Technology in wide use to conjure up detailed snapshots of a beating heart can mislead doctors and unnecessarily frighten patients, according to new research led by Cleveland Clinic imaging expert Mario J. Garcia, M.D.

A growing number of his patients fall prey to a fairly common glitch in many of the devices: false positives. That means results from a scan point to heart disease even though the patient is fine–although often poorer by the hundreds of dollars it cost to get the faulty test.

“They see an ad on TV, pay a lot for someone to run a CT scan, and are told that something doesn’t look right,” says Dr. Garcia, director of cardiac imaging at Cleveland Clinic. “They come to us distressed, and in some cases, we have to repeat multiple tests to demonstrate that they’re okay.” His new research casts light on why scanners make mistakes (July 26 2006 Journal of the American Medical Association). It raises warning flags for anyone considering buying cardiac evaluations after watching a commercial.

But despite his findings, Dr. Garcia predicts that the newest versions of the diagnostic equipment, called MDCT (for Multidetector Computed Tomography), are likely to play a greater role in diagnosing heart attacks and other cardiovascular afflictions. You can expect that MDCT will increasingly compete with the current gold standard for revealing arterial narrowing and heart attack. As the most advanced equipment comes into wider use, getting a good diagnosis will be simpler and faster for many patients, maybe you (see “A Comparatively Easy Way to Diagnose Heart Disease,” left). Already, MDCT–even earlier versions of it–is producing an impressive record of telling scared but healthy patients that in fact they don’t have heart disease.

Alternative to a gold standard

For now, the main route to an accurate diagnosis often leads to the catheterization laboratory for an invasive procedure called cardiac angiography. Doctors thread a thin tube (catheter) up from a groin artery to the top of the heart. As they watch two-dimensional X-ray images on a screen over the cath lab table, they inject X-ray contrast dye into the heart arteries–it shows up black on the screen–and watch it course rapidly toward heart muscle. Blockages show up as narrowing in the arteries on the screen, like the pinched midsection of an hourglass.

CT scans also require contrast dye, but it’s injected through an intravenous (IV) line into an arm vein instead of directly into the heart arteries. An earlier generation of diagnostic devices, called electron beam CT (EBCT) scanners, provided a stack of heart images like slices of raisin bread. One slice would reveal a little of the raisin, the next would show a little more, until doctors had enough slices to represent the entire raisin. “Those slices are relatively thick,” Dr. Garcia says, “and that’s why EBCT hasn’t panned out to be as accurate as the MDCT test.”

The newest MDCT scans create thinner slices, up to 64 of them with each pass of the X-ray camera over a portion of your chest. So they can provide a sharper 3D image of the whole “loaf”–the entire heart–at once (see an example, above).

EBCT focused primarily on detecting calcium, a component of the plaque that builds up in arterial walls. Plaque rupture sets the stage for heart attacks. By comparison, the latest scanners are the medical version of superheroes. They still scout for calcium. They can also generate detailed pictures of plaque without calcium, which may be more prone to rupture, Dr. Garcia says. MDCT’s X-ray vision can probe your heart muscle and soft tissue, and bring arterial narrowing into bold relief.

“MDCT has at least the potential to look at three bad causes of chest pain all at once,” says Deepak L. Bhatt, M.D., associate director, Cleveland Clinic Cardiovascular Coordinating Center.

“Depending on how you set up the scanner, you can open different windows into the chest,” he says. “You can set the windows to optimize the view of the heart arteries” for what doctors call a CT angio–non-invasive angiography. “You can get pictures of the aorta, the body’s main artery, leading up from the top of the heart, to see if there’s a tear in its wall, or examine blood vessels to the lungs to see if there’s a blood clot.”

In some cases, MDCT has inadvertently helped doctors find other diseases in the chest, like lung cancer.

What’s wrong with this picture?

If it’s so easy, why hasn’t non-invasive CT angio replaced the more cumbersome angiography test? The reason is that many of the scanners in use today don’t provide the clarity of the newest 64-slice equipment. The problem of false positives, revealed in Dr. Garcia’s recent research, appeared in older MDCT equipment producing just 16 slices.

In his study, he tested their accuracy at 11 different sites. A total of 187 patients underwent MDCT. Then–within one to 14 days–each went to the cath lab for conventional angiography for comparison.

Designed for clinical and industrial microscopy professionals, NIS-Elements Documentation delivers color documentation capabilities that include basic measuring and reporting. Analysis functions include object counting, automated measurements, and time lapse image capture. Report generator allows users to create report templates for PDF-based reports, while large image stitching capability enables ultra-high resolution images to be captured with motorized stage using auto focus.

NIS-Elements Documentation (NIS-Elements D) is the latest addition to Nikon’s imaging software suite designed to serve the needs of advanced bioresearch, clinical, industrial and documentation professionals. NIS- Elements Documentation software provides a totally integrated solution for users of Nikon and other manufacturers’ accessories by delivering color documentation capabilities that include basic measuring and reporting capabilities. The software optimizes the imaging process and workflow, and provides the critical element of integrated documentation information management for system based microscopy.

“Nikon’s Documentation Software addresses a fundamental, but critical requirement for clinical and industrial microscopy,” said Stan Schwartz, vice president, Nikon Instruments. “Our strategy is to establish Nikon Elements software as the preeminent platform for sophisticated image capture, document control, data management and analysis.”

Key modules in each NIS-Elements package include an optional database capability allowing one-click image acquisition and transfer from a camera to a user defined database. A report generator allows users to create report templates for PDF-based reports. The product also includes large image stitching capability so ultra-high resolution images can be captured with a motorized stage using sophisticated auto focus capabilities. Optional plug-in modules are available that utilize Extended Depth of Focus (EDF) allowing the creation of an all in-focus image from a series of Z-axis images. A single window GUI allows easy access to image documentation tools and speeds workflow.

Innovative analysis capability includes object counting, automated measurements and time lapse image capture. An advanced multi-layered document structure is standard. This sophisticated image documentation structure makes it possible to achieve non-destructive archiving of image data including annotation (arrows, lines, text notes), measurement data, binary data for storing results of threshold or classification processes, and meta-data information for recording acquisition and device conditions at the time of image acquisition. Flexibility in tailoring the software for specific applications is possible through simple built-in macro recording and the Advanced Macro Builder.

Vision Series PACS v5.0 includes embedded 3D and volume tools, giving users ability to manipulate complex CT and MR images with multiple imaging preset protocols, capture rendered images, and distribute them to referring physicians. Ability to review prior exams speeds workflow and provides for comparison of multiple studies, and embedded orthopedic templating is also available. Software has also received d FDA clearance to perform primary interpretation of digital mammography.

BOSTON, Nov. 21 — AMICAS, Inc. (NASDAQ:AMCS), a leader in radiology and medical image and information management solutions, has launched Vision Series PACS Version 5.0, a release representing significant advancements to its proven image management software platform. The launch will be highlighted at the 2006 Radiological Society of North America (RSNA) annual meeting from November 26th through December 1st, 2006, in Chicago, Illinois. Vision Series PACS Version 5.0 has already been successfully deployed at Tristan Associates in Harrisburg, Pennsylvania.

At the heart of Vision Series PACS Version 5.0 lies deep clinical innovation within the AMICAS LightBeam diagnostic workstation. Significant advancements have been made in functionality to support digital mammography, 3D rendering, and orthopedic templating. Mr. Rodney Hawkins, vice president of product development at AMICAS, Inc. said, “A great deal of our development effort with version 5.0 of our Vision Series PACS platform was designed to ensure that our customers are equipped with the necessary tools and workflow to thrive in a world of dramatic developments from the imaging modalities.”

Core Clinical Innovations in Version 5.0 Include:

Primary Reading for Digital Mammography - AMICAS has received FDA clearance to perform primary interpretation of digital mammography. This means that the AMICAS PACS platform supports the DICOM overlay functionality as delineated by the Mammography Quality Standards Act, in addition to other mammography-specific workflow enhancements. All of these enhancements are critical, given the recent introduction of CR and continued adoption of DR mammography systems.

Embedded 3D and Volume Tools - Embedded MPR/MIP functionality, including the ability to manipulate complex CT and MR images with multiple imaging preset protocols, capture rendered images, and distribute them to referring physicians.

Prior Exams - AMICAS has introduced significant innovation in the capability to quickly review and compare prior exams. With larger and more complex data sets in radiology, efficient reviews of prior exams speeds workflow and provides for the quick comparison of multiple studies.

Orthopedic Applications - Fully embedded orthopedic templating available on any Web-based workstation.

Version 5.0 also includes significant upgrades to the core infrastructure, keeping Vision Series PACS on the cutting edge of technology in Web-based PACS. Version 5.0 includes the latest operating system from Microsoft and the latest database and archive technology from IBM. The entire system utilizes the latest in Web services from Microsoft and Java. Kang Wang, PhD, vice president and chief technology officer for AMICAS said, “As a technology pioneer in Web-based PACS, we believe it is essential to continue to reinvest in our core technology and keep our systems on the latest technology.”

AMICAS also has enhanced the acclaimed Vision Watch monitoring tool with version 5.0. Vision Watch is a first-class remote monitoring tool that is fully embedded within the Vision Series PACS platform. Version 5.0 includes dramatic enhancements in the ability to set alerts, thresholds, and reports based upon user-configurable rules and delivery mechanisms.

Version 5.0 is also fully integrated with a single database and computing infrastructure with the new AMICAS Vision Reach(TM) product.

About AMICAS, Inc.

AMICAS, Inc. (www.amicas.com) is a leader in radiology and medical image and information management solutions. The AMICAS[R] Vision Series(TM) products provide a complete, end-to-end solution for imaging centers, ambulatory care facilities, and radiology practices. Acute care and hospital clients are provided a fully-integrated, HIS/RIS-independent PACS, featuring advanced enterprise workflow support and scalable design. Complementing the Vision Series product family is AMICAS Insight(TM) Solutions, a set of client- centered professional and consulting services that assist our customers with a well-planned transition to a digital enterprise.

A new state of the art Diagnostic Imaging Center, designed by Swanke Hayden Connell Architects (SHCA), has been completed for the North Shore–Long Island Jewish (LIJ) Health System in Lake Success, New York.

Part of North Shore–LIJ’s Center for Advanced Medicine, the 15,000 s/f facility contains the latest technology and is completely digital. Modalities include MRI, CT, SPECT and PETCT. Standard Radiography and Ultrasound rooms are also provided.

SHCA’s layout for the facility is organized with two different circulation zones, a patient circulation and a staff circulation, that both access the “procedure module.” This module consists of imaging procedure rooms that are serviced by a common “work core.” Here, staff can keep supplies and have access to clean and soiled utilities and other required support spaces, all in close proximity of the procedure rooms, while maintaining separation from patient/traffic interaction.

“The aesthetics of the Imaging Center are clean, warm and professional,” noted James Case, SHCA’s principal in charge of healthcare design.

“The reception area makes use of ceramic tile, carpet, bamboo, glass and natural lighting. The major modality rooms feature soothing accent wall colors, warm colored wood look flooring, spa inspired fabrics and indirect lighting.”

SHCA is currently working on two additional projects for North Shore–LIJ’s Center for Advanced Medicine in Lake Success. An 18,000 square foot Urology Center, currently under construction, and a new 7,500 s/f Mammography Center, also under construction.

A conference on “Clinical Applications of Imaging Technologies in the Management of the HIV Lipodystrophy Syndromes” will be held April 2-3, 2004 in Montreal. Speakers include Andrew Carr, Carl Grunfeld, Donald Kotler, Kathy Mulligan, Pablo Tebas, more than ten other physicians, and Bob Munk of New Mexico AIDS InfoNet on financial considerations.

The goal of this (University of Pennsylvania) proposed work is to improve the breast tumor diagnostic capabilities of optical spectroscopy and imaging, based on diffusing near-infrared light. New theoretical methodologies will be introduced for image reconstruction within the human breast, and it is planned to develop these theoretical approaches further and test them experimentally. The primary benefit derivable from these ideas is improved breast image fidelity, which in turn will enable clinicians to fully exploit the new spectroscopic and scattering contrast mechanisms available with the optical method, for increased tumor sensitivity and specificity.

Since submission of the proposal, work has experimentally demonstrated the theoretical ideas underlying the near-field Fast Fourier Transform approach. These experiments have produced 2-D projection images of thin objects embedded in infinite media. The apparatus, however, is not well suited for realistic parallel-plate soft breast compression geometries, so construction has been completed of an instrument that is far better suited for these more realistic studies. Various theoretical issues have been explored, including the effects of imaging filters on the reconstructions, and the potential for 3-D reconstruction.

The Medical Group Management Association (MGMA) traditionally provides an exhibit hall at makes others pale in comparison. This year, Oct. 3-6 in beautiful San Francisco, MGMA offers three days of exhibit hall exploration, with the chance to see an impressive array of information technology, to attendees at its annual conference. Suppliers of practice management systems, electronic medical records, scheduling, transcription and voice recognition services, wireless technology, credentialing info tech, financial and claims management systems and document management technologies will be on hand to demonstrate their products and help attendees consider what’s right for their organizations.

To help maximize your MGMA exhibit experience, Health Management Technology offers a showcase of some products you can personally test-drive at the conference. While you are there, stop by HMT Booth 1309 and say hello.

Companion Technologies Booth 523

Companion Technologies develops practice management, electronic medical records and electronic data interchange software.

Companion PM is a fully integrated practice management system that works on Windows, Unix and Linux platforms. Its modular design can be scaled to meet specialty-specific requirements while accommodating changes in practice size and organization. Companion EMR is a Windows-based electronic medical records system that works on PCs, handhelds, laptops and tablets. It provides local and remote access to clinical data and automates prescriptions, labs, encounters, medical histories, patient education, and more.

Hurco offers the VTXU five-axis VMC to machine complex, multi-sided parts where reduced setup time and part accuracy are critical. The machine is useful for components that are used in various medical imaging devices, retinal scanning systems, ophthalmology devices and dermatological systems.

Because the machine has five-sided conversational programming, only one part setup is necessary. In addition, the machine features a traveling column design and an integrated trunnion table that uses the company’s motion control. Compatible with most five-axis CAM programs, the machine features an ergonomic control console with a dual screen for displaying active graphics; a thermal stabilization package for the head; and coolant-through-spindle capability as high as 300 psi.

The 24-hp spindle is capable of speeds as fast as 12,000 rpm. XYZ axis travels are 31.5″ x 27.5″ x 20″. The 23.6″ x 19.7″ table can hold workpieces as heavy as 583 lbs. Rapid traverse is 1,378 ipm, and repeatability is 0.0001″. The machine’s swing-arm ATC can accomodate 32 CAT 40 toolholders.

Tokyo, Japan, Feb 5, 2007 - (JCN) - Olympus Medical Systems announced the release of Olympus Gif Type RQ260Z

Evis Lucera - a digestive tract video scope used for observing of blood vessels in mucous membranes under infrared light.

Blood vessels are observed this way to assess how far tumors have invaded and therefore how best to treat a particular patient’s stomach cancer. Infiltration of the cancer can be deduced by the proliferation of blood cells in the gastrointestinal mucous membranes.

The Evis Lucera video scope comes with a 90x zoom and a button that allows it to switch from normal to narrow band imaging. This special light setting, caused by irradiation of two hemoglobin-absorbed wavelengths, is used to display capillary blood vessels and mucous membranes patterns.

LIMITED HEALTH-CARE RESOURCES obligate physicians, employers, and third-party payors to periodically evaluate the cost-effectiveness of any medical assessment process. Evaluation is especially necessary when the process has become routine, as is the case with preemployment medical assessments. White-collar employees experience low risk at work. Office workers may perform multiple tasks, including answering the telephone, interacting with the public, handling money, receiving and delivering mail, typing and transcribing, operating office machinery, filing, and lifting supplies or parcels. Individuals may also perform professional duties (e.g., writing, editing, accounting, research, interviewing). Examples of white-collar occupations are government employees, telephone operators, clerks, and office equipment operators (e.g., computer programmers/technicians, financial workers). (1) All of these occupations are nonhazardous positions, and there is a lack of guidelines for preemployment health assessment of such workers.