The Promise of Modern Imaging P t i Patrice Bret B t Professor - - PowerPoint PPT Presentation
The Promise of Modern Imaging P t i Patrice Bret B t Professor & Chair Medical Imaging at University of Toronto Radiologist-in-Chief MSH, UHN & WCH Objectives To review the road map of Medical Imaging technology To reflect
The Promise of Modern Imaging
P t i B t Patrice Bret Professor & Chair Medical Imaging at University of Toronto Radiologist-in-Chief MSH, UHN & WCH
Imaging technology
changes in the “prescription” of MI examinations
function in Medical Imaging
g g
g g
p g p y analyze and distribute information to providers and consumers alike is the p number one priority for improving the health system y
The Health Care Restructuring Commission of Ontario, Canada – Forward on 2000
p printed reports, handwritten notes, analog voice dictation, faxes that all g provide a single copy of the data, often stored in the wrong place and have no g p potential for real time interactivity
& transfer data
it becomes usable it becomes usable
– This should be simple It is just a database It is in fact complex There are many barriers – It is in fact complex There are many barriers
The limiting factor is in part the software
– Various systems of reimbursement – Temporal changes in same region of the world
– Local expertise (US versus CT versus MRI)
– Various systems of reimbursement
PET distribution and availability – PET distribution and availability – PET reimbursement – “Privatization” of imaging centers
Differ in each province and even within each province Differ in each province and even within each province
prescription.
enhance consistency and implementation
Th id i ft t t
d t t i l id t demonstrate universal evidence or cost- effective strategies N d l t t tl
challenging cost-effectiveness models A l h i i i t t t
changes even when the evidence is there
pp
angiography? angiography?
can be applied across the medical community
taught or transferred to the community ill h i t will have an impact
the skills than to perfect the techniq e the skills than to perfect the technique
p g
Diagnostic / Therapeutic
Chest X-Ray, Abdominal series Bone Surveys y
– New design for patient flow – Requires an integrated network q g – Productivity gains needed to offset huge capital investment
g g p y p g p y
– Not sensitive Not specific – Not specific
Sensitive – Sensitive – Specific – Knowledge to perform and read them is – Knowledge to perform and read them is disappearing
g y g g avail.
No longer less expensive than cross sectional imaging in digital environment
cross sectional cross-sectional
* Chest X-Ray, Abdomen, Bones …
3 5x Rads 3.5x Rads LDCTT R d 19x Rads dCXR x Rads CTT
p g
Diagnostic / Therapeutic
breakthrough for tumor characterization, g
the inconsistency of results because of the operator’s dependence (standards f lit )
EMI, Hounsfield years y
2nd, 3rd generations
Spiral CT
Spiral CT
The MRI years
Multi detector CT
The new generation of MDCT g
q p ( ) limited contrast resolution
MDCT 3D imaging
– CTA (contrast contrast medium) – Co-registration with functional imaging – Co-registration with functional imaging
High spatial resolution allows CAD models models models models
– Mammography analysis g p y y – Detection of lung nodules – Polyp detection in virtual colonoscopy – Polyp detection in virtual colonoscopy
CT still remains a modality associated y with a low contrast resolution
MRI
– Morphology real-time interactive scanning – Functional - Molecular imaging – Functional - Molecular imaging
PET d PET b d t h l – PET and PET-based technology
p g
Diagnostic / Therapeutic
g g the switch from hyperplasia to neoplasia
Tumor secrets both promoters (vefg) and inhibitors of angiogenesis (endostatin). (endostatin).
y gy y predict likelihood of metastasis
Antiangiogenic agents are a challenge for morphologic imaging: Even when effective they do not shrink the tumor effective they do not shrink the tumor so dimensional measurements wont predict response therefore a need to predict response therefore a need to measure tumor blood flow, vascular permeability permeability
g g g g perfusion blood volume Ultrasound micro bubbles, PET, SPECT F18FDG, Water oxygen sestamibi for blood flow
MRI is the most investigated technique so far
– No tissue characterization
aspect of tissues aspect of tissues
– Understanding of biology – Imaging effectiveness of cancer treatment g g – Mapping gene therapy
p
– MRI, PET, contrast-enhanced US
p g
Diagnostic / Therapeutic
g g non invasive techniques
minimally invasive image-guided minimally invasive image-guided therapy
– Diagnosis with MRCP – Treatment with endoscopic techniques
Colon
– Diagnosis virtual coloscopy – Treatment with endoscopic techniques
Coronary
– Diagnosis with CT angiography – Treatment with cath-lab techniques
Cryoablation
Heated fluids: saline, alcohol, contrast
Breast, Bone.
p gy
– Enhancement Enhancement – Blood flow Measuring temperature: Heat-sensitive – Measuring temperature: Heat-sensitive sequences
Change is the key work
with “conventional” techniques
gaining acceptance
morphological and functional imaging is the current challenge
image guided therapy