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2008 IEEE International Ultrasonics Symposium (IUS)
Beijing International Convention Center (BICC)
Beijing, China, November 2-5, 2008 (View: Conf. Photos/Videos and Beijing Photos )
Sponsored by the IEEE Ultrasonics, Ferroelectrics, and Frequency Control Society
Special Clinical Session
Overview of Clinical Session Topics (Please Click on the Links to Jump to the Talks):
The 2008 IEEE International Ultrasonics Symposium will include a special clinical session to show how medical ultrasound technologies are used in clinical practices. This special session consists of the following half-hour invited presentations. Please click on the links below to jump directly to the talks. (Note: This session is organized by Dr. Stuart Foster, University of Toronto, Canada.)
Notes: To quickly find where the invited clinical session talks are scheduled in the conference technical program, please check the Condensed Program and the Floor Plan. You could also see more details of the technical program in the Full Program (Program Book), Abstract Book, and Meeting Planner. (Please use the labels such as "1E-1" to locate the corresponding sessions).
Title: Making Microbubbles Work for Ultrasound: Technical and Broader Challenges
Peter Burns, Dept Medical Biophysics, University of Toronto, Toronto, ON, Canada.
Background, Motivation and Objective: Although it has been 10 years since microbubble contrast agents were first approved for clinical use, adoption has been slow, in spite of considerable technical advances and many successful clinical studies.
Statement of Contribution/Methods: Methods for contrast specific imaging exploit the nonlinear response of bubbles at or near resonant excitation. Simple filtering for higher harmonics has given way to broadband methods using phase and/or amplitude modulation of a sequence of pulses. With suitable detection methods, linear, nonlinear, moving and stationary targets can all be segmented from the echo and shown in real time. The tendency of bubbles to disrupt at low peak negative pressures also offers a potential role for coded excitation on transmit. Deliberate disruption of bubbles with a few high MI pulses can clear the image plane and allow measurement of its replenishment by contrast offering a unique way to quantify microvascular flow and perfusion volume.
Results: At least 3 million clinical contrast studies have been performed: safety and tolerability have proven excellent. Clinical applications have focused on areas in which ultrasound already plays an important diagnostic role. In cardiology, contrast can aid visualisation of the endocardium, especially important in wall motion studies, and has been shown to improve the accuracy of stress echo. It can also image and measure myocardial perfusion in real time, at rest and with stress, with spatial resolution superior to the current nuclear medicine standard, SPECT. In radiology, perfusion can be imaged in many organs, but work has concentrated on the liver, where contrast can help characterise focal lesions with an accuracy comparable to contrast CT and MRI. It also aids in lesion detection, in real time guidance of interventions such as RF ablation and in monitoring response to tumor therapy, especially using the new antiangiogenic agents.
Discussion and Conclusions: In spite of demonstrated efficacy and safety, widespread adoption into the clinic has been slow. Two reasons are proposed. First, although bubbles are approved for perfusion imaging in more than 60 countries, the US, which has approved no radiology indications, is not among them. Second, while contrast ultrasound is often less expensive than competing modalities, physician reimbursement may be less too, dampening enthusiasm among practitioners. We conclude that future clinical studies should focus on applications unique to microbubbles, exploiting, for example, their confinement to the blood pool and the ability to image them in real time. Approval of a perfusion indication by the US FDA is crucial. Widely available, robust contrast specific imaging modes are needed. The intriguing capacity of bubbles to potentiate therapies, including drug delivery, should be pursued. For diagnosis, translation of microbubble contrast applications to clinical practice may come more quickly in cost driven rather than profit-driven healthcare systems.
Dr. Peter Burns is Professor and Chairman of Medical Biophysics and Professor of Radiology at the University of Toronto and Senior Scientist at Sunnybrook Health Sciences Centre, Toronto. He received his degree in Mathematical Physics in 1973 and, following a postgraduate fellowship in History and Philosophy of Science, a PhD in Radiodiagnosis in 1983. He subsequently held faculty positions in Radiology at Yale University and Thomas Jefferson University in Philadelphia. He moved to Toronto in 1991. He was part early efforts to detect flow in small blood vessels with Doppler, including the first ultrasonic detection of tumor blood flow. He subsequently worked on Doppler methods for flow detection and hemodynamic measurement in the abdomen and pelvis. In 1988 he began research with microbubbles as ultrasound contrast agents, focusing on the development of nonlinear methods such as harmonic, pulse inversion and amplitude modulation imaging as well as their clinical applications in perfusion imaging of the heart, abdomen and tumors. He has published more than 130 papers, 4 books and holds several patents in diagnostic ultrasound. He received the World Federation of Ultrasound in Medicine and Biology Pioneer Award (1988); the Ian Donald Gold Medal for Technical Achievement (2002); Innovation and Excellence Trophy of the Société Canadienne de Radiologie (2002), was the Euroson Lecturer of the European Society for Ultrasound in Medicine (2005); the Donald McVicar and Brown Lecturer of British Medical Ultrasound Society (2006) and is the IEEE Ultrasonics, Ferroelectrics, and Frequency Control Society Distinguished Lecturer for 2008.
Title: The Clinical Application of Ultrasound Contrast Imaging
Yuxin Jiang, Department of Diagnostic Ultrasound, Pekin Union Medical College Hospital, Beijing, China.
Background, Motivation and Objective: Contrast-enhanced ultrasound imaging is the area of greatest interest in ultrasound medicine currently. The recent improvements of contrast agent and the contrast specific scanning techniques have given new possibilities for the further research and clinical application. We are having researches in the basic theory study and further clinical applications in China, so that ultrasound contrast imaging can be better recognized and widely applied in the clinical practice.
Statement of Contribution/Methods: The introduction of second-generation microbubble contrast agents, such as SonoVue and self-made perfluorocarbon ultrasound contrast agent, and the advent of specialized imaging techniques enabled real-time contrast-enhanced imaging. In our study, Sonovue and the gray scale harmonic imaging technique were adopted to evaluate the characteristic contrast enhanced pattern of liver, kidney, gynecology, breast and thyroid lesions, etc.
Results: Our clinical research shows that contrast enhanced ultrasounographic imaging can improve the diagnostic potential of sonographic examinations in different clinical applications, including the better observation of small vessels, the real-time assessment of the blood perfusion pattern in an organ or area of interest, with a significantly higher detection rate and diagnostic accuracy especially for the tumor of liver, kidney and gynecology. Otherwise, contrast enhanced ultrasound imaging holds the potential for a better visualization and diagnosis of peripheral vascular and some deep-located vessels, such as carotid, brain arteries and renal arteries, etc. The area of great promise and growth also lies in the clinical research of breast and thyroid.
Discussion and Conclusions: With the fast development and the intrinsic advantages of contrast enhanced ultrasound imaging, it is gainning more and more popularity. Ultrasound doctors should pay efforts to do further research in this state of art technique, which may open a new prospect for the ultrasound medicine.
Dr. Yuxin Jiang is a director of the Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Beijing, China; Professor of the Chinese Academy of Medical Sciences & Peking Union Medical College in Beijing, China; President of the Society of Ultrasound in Medicine of Chinese Medical Association. Dr. Jiang has lead a team from China to present at ASUM ASM 2006 on topics relating to ultrasound guided therapy, e.g., use of contrast in ultrasound, and various interventional techniques. Dr. Jiang will discuss topics relating to ultrasound guided therapy, e.g., HIFU and Radio Frequency, use of contrast agents in ultrasound, and various interventional techniques now used in China.
Title: The Role of Contrast Enhanced Ultrasound (CEUS) in Oncology
Stephanie Wilson, Department of Diagnostic Imaging, Foothills Medical Centre, Calgary AB, Canada.
Background, Motivation and Objective: The oncology patient is susceptible to the development of tumor masses in many locations and their detection and diagnosis is usually within the realm of diagnostic imaging. While ultrasound may show tumors, additional imaging with CT and or MR scan is generally required for their confident diagnosis. We address the tremendous contribution of contrast enhanced ultrasound (CEUS) in the imaging of this population.
Statement of Contribution/Methods: Contrast agents for ultrasound are comprised of tiny bubbles of gas in a supporting shell. Their intravenous injection results in tissue perfusion, analogous to that seen on contrast enhanced CT and MR, and also incredible vessel visualization more similar to that seen with angiography. These attributes allow for improved detection and characterization of tumors in many parts of the body.
Results: Characterization of tumors of the liver is the most accepted indication for CEUS where it is complimentary to CT and MR scan. Liver lesion detection and also the difficult question of diagnosis of hepatocellular carcinoma are further accepted strategies for the use of CEUS as the detection of small nodules in the cirrhotic liver on screening sonography is enhanced by the performance of CEUS at the time of nodule detection. Detection of liver masses is also improved by CEUS as the addition of contrast agent increases the conspicuity of liver masses on sonography such that more and smaller masses may be detected than at baseline.
CEUS is also valuable when added to intraoperative liver ultrasound, contributing to management decisions for the patient undergoing surgery. Further, CEUS is a critical component of radiofrequency ablation (RFA) techniques especially when performed at the time of the procedure where it may reduce the requirement for repeat procedures performed for incomplete ablation. CEUS is suitable for monitoring patients with prior RFA or transarterial chemoembolization (TACE).
CEUS contributes to the characterization of renal masses, especially cystic RCC, where vascularity in septae and nodules is shown with a sensitivity surpassing both CT and MR scan. Further, in other locations such as the pancreas, spleen, ovary, prostate and breast, CEUS may show the presence of vascularity in real-time with the resolution of standard gray-scale ultrasound.
Discussion and Conclusions: CEUS changes totally the role of ultrasound in the evaluation of the patient with cancer. CEUS may be performed on any organ with a suitable acoustic window where the addition of vascular information may contribute to diagnosis. Its performance is independent of renal function making it a perfect first choice for the characterization of all masses in the oncology patient. To confirm that a mass is a malignant tumor or to confirm that it is not, CEUS is an easily performed and readily available technique. For these reasons, CEUS deserves a fundamental role in the future of oncological diagnosis.
Dr. Stephanie R. Wilson was born and educated in Western Canada but has made Toronto her home for the duration of her professional life. In 2007, she relocated to her home province where she is now Professor of Radiology at the University of Calgary and a member of the department of Diagnostic Imaging at Foothills Medical Centre, Calgary, CANADA. Dr Wilson has invested her research, academic and practice pursuits on imaging of the gastrointestinal tract, pancreas and liver. Since 1992, Dr Wilson has collaborated with Dr. Peter Burns from University of Toronto/Medical Imaging Research on the investigation of microbubble contrast agents for the evaluation of their use in Medical Imaging. Their major accomplishments to date include their investigation of the diagnosis and characterization of tumors of the liver. Burns and Wilson shared a grant from the Canadian Institute for Health Research (CHIR) for these investigations.
Apart from her research pursuits, Dr. Wilson has been the recipient of annual prestigious University of Toronto Faculty of Medicine teaching awards including the Colin R. Woolf Award for Excellence in Continuing Education Teaching in 1992, and the Wightman-Berris Academy Award for Individual Teaching Excellence in 2005. She has authored over 100 peer reviewed publications and many book chapters and is an editor of the highly successful two volume reference on ultrasound, entitled Diagnostic Ultrasound, often referred to as the “Bible of Ultrasound”, now in its third edition. Dr Wilson served as the first woman president of the Canadian Association of Radiologists and was also the recipient of their Gold Medal for her contribution to radiology.
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