|
|
A publication by ARDMS - The globally recognized standard of excellence in sonography - www.ARDMS.org
51 Monroe Street - Plaza East One - Rockville, MD 20850 - (800) 541-9754
Visit the ARDMS homepage
“Articles for you, from us”
Get connected with NewsWire! Share your thoughts, articles or suggestions.
Welcome to NewsWire! This bi-weekly e-newsletter from the American Registry for Diagnostic Medical Sonography® (ARDMS®), offers its Registrants and members of the sonography community current and innovative news and technology related to the field of sonography.
We want to hear from you! NewsWire was designed to serve as an informational forum. As such, we welcome your article suggestions, questions, comments and feedback on ways to make this resource a more valuable tool in your day-to-day professional life. Please write to us at: communications@ardms.org |
|
|
|
|
|
New algorithm sharpens coronary artery images
New developments aim to simplify the difficult task of evaluation coronary artery images.
Researchers at the recent Computer Assisted Radiology and Surgery (CARS) meeting in Barcelona presented new work that aims to simplify the difficult task of evaluating coronary artery images.
Researchers from Germany say their new automated phase-selection method yields sharper coronary artery reconstructions by mapping the centerline of each segment -- and rejecting phases whose centerlines stray too far from the mean.
To finish cleaning up the images, a motion-compensation technique then deforms the projections in each segment to line up the vessels in 3D. This step further minimizes blur, paving the way to better treatment planning and follow-up.
 Three-dimensional reconstructions of the coronary arteries, based on electrocardiogram (ECG)-gated acquisition, offer great advantages over 2D mapping produced by gold-standard coronary angiography, said principal investigator Eberhard Hansis from
Philips Healthcare research in Hamburg, and the University of Karlsruhe in Karlsruhe, Germany, in his presentation.
The quality of 3D reconstructions varies over the cardiac cycle. It is usually best near the end-systolic and end-diastolic rest phases, but the optimal phase cannot be predicted before the acquisition.
"Unfortunately, the optimal phase depends on heart rate; it also varies from patient to patient and varies [depending] on whether we are looking at the left or the right branch. So for each phase we need an automated method to detect the optimal recon phase," Hansis said.
Previous approaches to the phase-selection question include histogram-based automated techniques, and alternate methods based on choosing phases with the least motion in a single plane.
The proposed automated phase-selection process selects heart phases with minimum inconsistency of the motion state in selected projection data. A projection-based motion-compensation method then deforms all of the projections in order to overlay them in the 3D space. The combined techniques yielded consistently improved visualization of arteries compared to manually selected reconstruction phases.
While the researchers' advanced image-processing methods were applied to 3D rotational coronary angiography for purposes of the study, they could also be adapted to MDCT.
3D rotational acquisition
Coronary angiography images are acquired with 3D rotational angiography, which puts the patient's heart at the center of a conventional C-arm system, Hansis said. Once the arteries are opacified by contrast agent injection, images are acquired with the system rotating approximately 180° for seven seconds while acquiring 210 projections in a sequence spanning 5-10 heartbeats.
"From this rotational acquisition, 3D reconstructions of the coronary arteries can be produced for use in diagnosis, quantitative vessel assessment, or interventional planning, for example finding the optimal viewing angles for a lesion," Hansis explained. "To perform 3D reconstructions in one cardiac phase we select the projections belonging to that phase from the whole sequence by using ECG gating."
As in MDCT acquisition of coronary artery images, however, picking the wrong phase leads to blurred images and impaired diagnoses. The proposed method aims to optimize phase selection "by looking for the ones with the best consistency of the vessel centerline in 3D," Hansis said. "By this we mean that the angiograms should consistently show the coronary arteries in the same locations."
Automated phase selection
"Let's assume we have three projections belonging to one cardiac phase," Hansis proposed. "In each projection we calculate at each point the square distance to the closest centerline of the artery segment." The resulting square-distance map is then backprojected into a 3D reconstruction volume, he said.
Next, the contributions from each backprojection are calculated to create a volume-distance map with a minimum value at the 3D position of the vessel centerline. In this manner, consistent projections yield low minimum values, while the measurements from inconsistent projections are higher, Hansis said. Thus, the centerline geometry of each vessel is used to detect phases with minimum inconsistency of the motion states to the corresponding angiograms.
"We repeat the whole process for all cardiac phases and then arrive at a curve [demonstrating] the inconsistency of the vessel centerlines over the cardiac cycle," he said. The minima of this curve represents the optimal reconstruction phase.
"We evaluated this method on 22 clinical cases," Hansis said. "For each case, two optimal phases, one in end-systole and one in late-diastole, were automatically projected and all of the cases were judged by three observers."
In all, 82% of the cases showed optimal image quality, 14% showed image quality slightly lower than optimum, and only 5% produced image quality considerably lower than optimum, Hansis said. In all 22 cases at least one of the two phases, either end-systole or late-diastole, showed optimal image quality, he said.
Motion compensation
Even if the optimal reconstruction phases are chosen, however, the heart's motion state isn't consistent in all angiograms due to factors such as residual heart motion, breathing, or imperfect gating. "These motion effects are, of course, stronger in non-optimal reconstruction phases," Hansis added.
This is where the second method, 2D motion compensation, comes in. The method differs from previous motion-compensated reconstruction methods, which incorporate 3D motion information into the reconstruction itself. In the proposed method, reconstruction of motion-compensated angiograms can be performed with any reconstruction model; the authors chose a filtered back projection technique for the study.
Like phase selection, the motion-compensation process begins with projections selected for the reconstruction of a single cardiac phase by ECG gating, Hansis said. A reference reconstruction is performed, and then a maximum-intensity forward projection is calculated onto each angiogram.
"Now we apply an elastic registration algorithm, which deforms the projection data such that the vessel centerlines match as well as possible," he said. "Here we use an iterative closest-point approach" using the vessel centerlines as marker points.
The transformation increases the consistency of each of the angiograms with respect to the coronary artery geometry, he said. The process is repeated for all projections. The resulting images reduce the influence of both noise and imperfect centerline filtering, yielding clearer reconstructions with less motion blur, Hansis said.
"We tried this method on a dynamic coronary heartbeat phantom that performs a beating motion," he said. The results showed improved accuracy in reconstructed vessel radii due to motion compensation.
According to these results, for a gating window of 40% the average error in reconstructed vessel radii dropped from 10.5% to 7.3% for the best phase and from 25.6% to 12% averaged over the entire cardiac cycle.
Robust
"This method proved to be robust and accurate in the evaluation of 22 clinical cases" as an optimal phase compensation method which looks for phases with the best centerline consistency, Hansis said.
As for the second method, projection-based motion compensation, a key advantage is that it does not rely on a specific coronary artery model, so it can be easily integrated into existing reconstruction methods, he said. It is also fully automated and delivers improved image quality with less blur and far greater detail.
"The combination of these methods may lead to high-quality 3D coronary artery reconstruction," he said.
View the article online.
Article written by staff at auntminnie.com and adapted for the purposes of this newsletter.
Back to Top
|
|
|
Intravascular ultrasound (IVUS) may reduce drug-elating stent thrombosis by a third
IVUS guidance has the potential to influence treatment strategy and reduce both thrombosis and repeat revascularization.
|
An article published in European Heart Journal describes a retrospective observational study of almost 1,800 patients in whom drug-eluting stents had been placed between April 2003 and May 2006 at a single center: the Washington Hospital Center in Washington, DC, where IVUS guidance is used in approximately 70% of coronary interventions.
The patient population was split into two groups (IVUS and non-IVUS) of 884 each, using a propensity-score for matching, in order to minimize any confounding impact due to lesion type, patient characteristics, etc. | The article describes a retrospective observational study of almost 1,800 patients in whom drug-eluting stents had been placed between April 2003 and May 2006 at a single center: the Washington Hospital Center in Washington, DC, where IVUS guidance is used in approximately 70% of coronary interventions.
The patient population was split into two groups (IVUS and non-IVUS) of 884 each, using a propensity-score for matching, in order to minimize any confounding impact due to lesion type, patient characteristics, etc.
The clinical endpoint of the study was definite stent thrombosis at 12 months, which was measured at three intervals: in-hospital, at 30 days and again at one year. The results were striking, surprising even the investigators. At 12 months, definite stent thrombosis had occurred in 0.7% of the patients in whom intravascular ultrasound guidance had been utilized, but in patients where IVUS was not used, the stent thrombosis rate was 2.0%, almost three times higher.
The advantages of IVUS have been written about extensively, but there has never been a study published that showed IVUS benefitted patients with drug-eluting stents in terms of stent thrombosis. Dr. Ron Waksman, corresponding author of the study said:
|
"There are some situations in which IVUS tells you a lot: for example, in-stent restenosis. If you want to know whether this is a mechanical issue versus a tissue issue, IVUS is very helpful. If you go to selection of [stent] length and size, that applies to every lesion. Even if you think that you know the size, you may be surprised that you are not accurate just by doing angiography alone. So there are a lot of helpful hints that you can get from IVUS.
"But perhaps the most important one applying to the drug-eluting stent is to obtain sufficient cross-sectional area after deployment of the stent -- to see that indeed the stent is well-expanded, and also well-apposed to the vessel wall. But I think the emphasis is on expansion, because sometimes you can miss on the expansion of the stent without an IVUS. Again, I think systematic use of IVUS post-stenting, enabling you to ensure expansion, to get the ideal cross-sectional area, probably will you get you out of trouble or may in the future." |
If a stent is not fully expanded against the arterial wall, the small nooks and crannies left between the stent and wall can be a nexus for platelet aggregation, resulting in a blood clot, otherwise known as stent thrombosis -- which can be very serious. Dr. Waksman explained that most of the stent thrombosis in the study occurred in the first 30 days, and that this type of stent thrombosis is more related to mechanical issues, whereas late stent thrombosis, occurring after a year or more, is more tied to healing and inflammation or responsiveness to Plavix. His study only dealt with the type of stent thrombosis occurring in the first year -- which also occurs more frequently
than the late type.
The study also concludes the IVUS guidance "has the potential to influence treatment strategy" because IVUS can show information about the lesion in a way that standard angiography cannot: for example, whether the lesion is eccentric, jagged, calcified in certain areas -- information that might suggest the use of a cutting balloon or Rotablator atherectomy device to pre-treat the lesion and allow the stent to fit more uniformly. In the case of a bifurcation lesion, Dr. Waksman felt that IVUS would be "almost essential" in order to judge whether the two stents have been completely expanded.
The results of the study showed no significant difference in death or MI, but did reveal a trend toward lower target lesion revascularization (TLR) in the IVUS patients (5.1% as opposed to 7.2%) suggesting that IVUS use may also impact the occurence of restenosis.
With IVUS use in the United States hovering in the low teens, Dr. Waksman feels that more interventional cardiologists should be thinking about it. He told:
"I would think that 13% is not sufficient, so there is room to be more liberal with the use of IVUS. The excuse that it's cumbersome is fading slowly because we have now integrated systems, so I think that at this point this is becoming a more essential tool and there are really not many complications associated with it. As to it being time-consuming, it's also becoming relatively simple to use.
"So I would encourage cardiologists to use it more, just based on those results because, now that we've been published, I think that this is an opportunity for even good operators to end with better outcomes. And if that's the case, then it's definitely important also for those who feel less comfortable in the cath lab with complex angioplasty. Here we have a tool that can optimize your result and you should not spare it on the patient."
View the article online.
Article written by staff at angioplasty.org and adapted for the purposes of this newsletter.
Back to Top
|
|
|
|
Food and Drug Administration (FDA) ultrasound contrast safety meeting sparks discussion, hope for the future
Ultrasound contrast advocates and representatives from the FDA hope the recent meeting on technology will help advance the development of the field.
Both ultrasound contrast advocates and representatives from the U.S. Food and Drug Administration (FDA) hope the recent advisory committee meeting on the technology will help to advance the development of the field.
"We came away very pleased with the committee, the discussions, and their level of thought as they grappled with this class of agents," said Dr. Karen Weiss, deputy director of the FDA's Office of Oncology Drug Products.
The FDA had called the meeting of the Cardiovascular and Renal Drugs Advisory Committee in Washington, DC, to provide a public forum for review of the history of currently marketed ultrasound contrast agents, to obtain opinions from the advisors regarding safety considerations in the development of these agents, and to begin to familiarize committee members with the review of diagnostic imaging agents, according to the agency. The meeting was also prompted in part by recent safety considerations for the agents, as well as the development of company risk management plans, the FDA said in pre-meeting documents.
It came on the heels of a turbulent period for echocardiography contrast regulation in the United States. The FDA had requested a "black box" warning in October 2007 for the Definity (Lantheus Medical Imaging, North Billerica, MA) and Optison (GE Healthcare
, Chalfont St. Giles, U.K.) echocardiography contrast agents after receiving reports of some deaths and serious adverse reactions. The agency later scaled back the warnings earlier this year, following an extensive lobbying campaign from physicians and societies such as the American Society of Echocardiography (ASE).
"The purpose of this advisory meeting was to really get some broader public input on how to develop contrast agents, how to move forward with new agents," Weiss said. "That was the main goal of the meeting, [covering issues such as] what stock to place on animal studies, and how to best identify rare but potentially serious adverse events given some of the constraints of doing controlled trials premarketing."
As part of the meeting, representatives speaking on behalf of ultrasound contrast companies GE, Lantheus, and Bracco of Milan, Italy, gave detailed talks on the strong safety record, clinical utility, and postmarketing surveillance of the Optison, Definity, and SonoVue ultrasound contrast agents.
"[The meeting] was a very good thing for us," said Dr. Steven Feinstein, director of echocardiography at Rush University Medical Center in Chicago; Feinstein spoke on behalf of GE at the meeting. "It allowed us to explore the data that we've all worked on in the last six or eight months, present it to them, and have a very reasoned and thoughtful hearing."
Lantheus representatives also felt they made an effective case for the safety record of Definity.
"At the end of the day, I think we could make a fair summary that there was a very positive benefit-risk balance for the use of Definity across the board and in different patient populations," said Dr. Mark Hibberd, Ph.D., senior medical director of global medical affairs at Lantheus.
The meeting was a good opportunity to present the objective safety data to the committee that will likely adjudicate future safety issues and be involved in the approval of novel imaging agents in the future, said Dr. Michael Main of the Mid America Heart Institute in Kansas City. He also presented data on behalf of Lantheus at the meeting.
Dr. Roxy Senior, director of cardiac research at Northwick Park Hospital in Harrow, Middlesex, U.K., discussed the safety record and clinical utility of SonoVue, which is not yet cleared for use in the U.S.
"The FDA appears to be happy with the safety data provided, but would like us to elucidate the mechanism of the serious events, which in most cases is allergy-like reactions," he wrote. "The FDA acknowledged that it may be difficult to uncover the mechanism, because it is extremely rare (1:11,000)."
While the goal of the meeting wasn't to focus on the safety of the agents, the presenters did provide a lot of compelling information on safety in their talks, FDA's Weiss said.
"I think they provided some very, very good evidence of their long years [of experience] and large patient databases," she said.
Post-approval trials
While defining the safety of contrast agents can be partially accomplished in the context of randomized trials during their development, it also requires formal, prospective observational trials after approval, said Dr. William Hiatt, chair of the advisory committee and president of the Colorado Prevention Center in Denver.
That suggestion isn't necessarily a radical recommendation, Weiss said. When products potentially provide a very important clinical benefit, the amount of premarketing data will necessarily be somewhat limited because it's difficult to identify rare adverse events.
"That's why we rely heavily on post-marketing, more epidemiological types of studies, observational studies, to try and tease apart events that occur when something is out there and used potentially in somewhat sicker patients or patients with other medications for other uses," she said. "I think their advice is very good, it's something that the group that does the new drug reviews -- our division -- and the group that deals with post-marketing safety, will just need to work closely together on as new products get to market and try to determine how best to design post-marketing, large studies that may not necessarily have a concurrent control group, to try to
assess adverse events."
Another strong point of consensus was the need to implement registries of serious adverse events as drugs are approved and monitored, Feinstein said.
"And I think that we all believe that," Feinstein said. "If you start looking back, the reason the FDA was probably forced to act was because they didn't have access to this [type of registry]."
With respect to safety, the committee wanted research to continue to look for patient populations that might be of special risk to adverse events, Hibberd said. It hasn't been possible so far to clearly identify those who may be at greater risk due to the rare nature of these adverse events, he said. And even those rare events are likely to be pseudo complications, more related to the patient's underlying illness.
"The best way of [looking at this risk] is with large cohorts of data that are accumulated by hospital systems or by multicenter experiences across hospital networks or large outcomes databases that collect data from literally millions of patient experiences, to try and tease out if any of them are at special risk," Lantheus' Hibberd said. "And if they are, then things could be done to make sure that special precautions are taken if those patients still require a contrast echo for any reason."
Effect on outcomes
Another suggestion from the committee pertained to the clinical efficacy of the agents.
"The primary end points of the trials to support the approval of new agents should not just focus on a better image (a 'pretty picture'), but also on how a better image leads to a better clinical outcome," Hiatt said.
That suggestion will require quite a bit more discussion, however, Weiss said.
"Imaging products are very different from therapeutic agents," she said. "We developed guidance a number of years ago on various types of claims that can be made for an imaging agent. In some settings, just looking at the picture, the structure, in and of itself can be a clinical benefit."
For example, many ultrasound contrast users talk about its ability to show a thrombus in the heart cavity, she said.
"I think everybody in the community would agree that if you can see that, and take action to treat that, that would be a clinical benefit," Weiss said.
Moving forward, the results from the committee meeting will help the FDA provide guidance to new ultrasound contrast agent developers on how to design premarketing studies and also how to develop a post-marketing database, she said.
A fair amount of discussion also covered preclinical models, and whether or not the pig, for instance, is a good model to use in development, Weiss said.
"The committee gave us some good advice that the sensitive models [such as the pig] are good, not to take as face value, but as good signal generators," she said.
The FDA foresees an important role in ultrasound contrast for the advisory committee.
"With this sort of introduction to this class of agents and the advice that we've already got, I think it'll be very good to take marketing applications to the committee in the future," she said. "There might be a time, too, where we want to go over with this committee the guidance that was developed on imaging agents and the claims that can be used for imaging-based agents."
While a number of presentations at the meeting dealt with the radiology applications of ultrasound contrast agents, the FDA is not yet ready to formulate opinions about how to develop those new uses, Weiss said.
"We're really not prepared to talk about that at this point," she said.
Ultrasound contrast advocates continue to remain optimistic, however, for the future of the technology. The use of contrast echocardiography is likely to grow, owing to the unique information it provides about the microcirculation, according to Senior.
"And it can be performed at the bedside in real-time unlike other competing technologies," Senior said.
With the FDA's reversal of most of the black box contraindications in May, ultrasound contrast is in a better place right now, Main said.
"Unfortunately, a number of physicians and hospitals still harbor some reservations about using these agents due to the continued presence of the black box warning, which in some people's opinions raises medicolegal issues with respect to use," he said. "That's a bad thing for patients at those hospitals, because they don't have access to the best diagnostic testing available."
"In contrast echocardiography, as we demonstrated at the meeting, we have a technique that's at least 10- to 100-fold safer than alternative imaging procedures, most of which involve radiation exposure or an invasive test," Main continued. "I and my colleagues all feel that the continued presence of the black box warning on these agents is not indicated and is really hurting patients by its negative effect on use."
View the article online.
Article written by staff at auntminnie.com and adapted for the purposes of this newsletter.
Back to Top
|
|
|
Method may ease birth weight calculations for obese moms
Birth weight projections based on ultrasound measurements earlier in pregnancy may be better then standard prediction methods for obese women
Birth weight projection based on ultrasound measurements earlier in pregnancy may be better than standard prediction methods for obese women, researchers said.
Action Points
One such method using ultrasound measurement at 34 to 36 weeks predicted birth weight within 20% accuracy in more than 90% of cases, reported Loralei Thornburg, M.D., of the University of Rochester Strong Memorial Hospital here, and colleagues in the July issue of Ultrasound in Obstetrics and  Gynecology.
In their retrospective study, this gestation-adjusted prediction (GAP) method had lower sensitivity among morbidly obese women for the clinically important prediction of macrosomia, but could exclude macrosomia with more than 90% accuracy regardless of maternal body mass index.
Obesity is a risk factor for almost all obstetric complications as well as fetal macrosomia, or birth weight over 4,000 g, which is associated with both neonatal and maternal morbidity.
But obesity can make accurate predictions of birth weight difficult by obscuring fetal anatomy on ultrasound, the researchers said.
Particularly in obese patients, visualization is easier earlier in gestation, they said. "At term there is significant deterioration of resolution as the fluid-to-fetus ratio decreases, bony structures become increasingly calcified, and the vertex descends in the pelvis, making measurements of head circumference and biparietal diameter more difficult."
Although there are other methods of predicting birth weight before term, the gestational-adjusted prediction method may be best because it is particularly easy and readily accessible to the clinician, Dr. Thornburg's group said.
However, "whether any method of birth weight prediction can alter fetal outcome remains to be seen," they noted.
The study included all women with singleton pregnancies who had ultrasound assessment between 34 and 36 weeks' gestation at the University of Rochester from May 1994 through July 2000.
The cohort included 1,025 women with a body mass index below 30.0 kg/m2 as a control group and 357 obese women, of whom 159 had a BMI of 30 to 34.9 kg/m2, 105 had a BMI of 35 to 40 kg/m2, and 93 had a BMI above 40 kg/m2.
Standard ultrasound techniques were used along with the gestational-adjusted prediction method.
The method calculates the ratio between the current fetal weight estimated by fetal ultrasound and the median fetal weight for the gestational age at which the sonogram was performed.
This ratio is then multiplied by the median birth weight at the gestational age of delivery to give the predicted birth weight.
The method's predictions were correct within 20% of the actual birth weight in over 90% of cases for all maternal BMI groups.
The predictions likewise were within 15% in more than 80% of cases and within 10% in at least 60% of cases for all groups.
Overall, the method performed as well for obese patients as for non-obese controls, but less well in those with a BMI over 40 kg/m2.
The method tended to overestimate actual birth weight among non-obese women and women with a BMI from 30 to 34.9 and 35 to 40 kg/m2 whereas it underestimated birth weight among those in the highest BMI category (mean error 4.2%, 3.2%, 3.1%, and -1.9%, respectively, P<0.0001).
"This may be owing to increasing maternal obesity, or it may be owing to relatively larger infant weights in the patients with [morbid] obesity," the researchers said.
Birth weight increased with maternal BMI, as did the percentage of patients with macrosomia -- defined as birth weight over 4,000 g (about 8.8 lb).
"Although birth weight prediction is important, prediction of macrosomia is the primary clinical use of many birth weight prediction methods," the researchers noted.
For macrosomia, the gestational-adjusted prediction method had only moderate sensitivity (48% to 60%) and positive predictive value (45% to 70%) for all maternal BMI groups. However, the specificity was high at 90% to 95%, as was the negative predictive value at 81% to 96%.
The "good accuracy in excluding macrosomia," Dr. Thornburg's group said, "is the more important clinical measure when counseling patients." They concluded that further study is warranted to compare this method with other prediction methods.
They cautioned that the study was limited by its retrospective design, particularly because women referred for ultrasound at 34 to 36 weeks' gestation may have been more likely to have chronic disease and not be representative of the general population.
View the article online.
Article written by staff at medpagetoday.com and adapted for the purposes of this newsletter.
Back to Top
|
|
|
Lothian leading the way cancer care
Physicians in the United Kingdom are pioneering a new form of diagnostic procedure that could help them in the treatment of patients with lung cancer.
Physcians in Edinburgh are pioneering a new form of diagnostic procedure that could help them in the treatment of patients with lung cancer.
The Royal Infirmary of Edinburgh is one of only two reference centers in the UK for this procedure - called the Endobronchial Ultrasound (EBUS) - and its doctors are among the world's leading experts in this subject.
The new technique combines a bronchoscope - a narrow tube with a camera and sampling instruments attached, which is passed into the patient's airways - and an ultrasound probe.
The latter allows doctors to study images beneath the surface of the bronchial wall and check if the cancer has spread to the lymph nodes.
Callum Gordon, service manager for cardiac, thoracic and respiratory services at NHS Lothian, said: "EBUS is a much more effective tool than a straightforward bronchoscopy. It allows specialists to remove much finer tissue samples from the areas they're looking at, and allows them to identify how far the disease has progressed.
"If the tumor has not yet spread to the lymph nodes surrounding the lungs, the patient may be suitable for surgery, which improves his/her chances of staying cancer free.
"If the cancer has spread, then an operation may not be the best route, and other forms of treatment such as radiotherapy or chemotherapy may be more suitable." EBUS gives doctors better information as to the state of the disease and helps them make treatment decisions at an earlier stage on the patient pathway. It's early days, but the future for EBUS looks promising."
In the past two years, EBUS has reduced the number of mediastinoscopies - where surgeons operate to investigate the spread of the cancer - by 20%, and experts are convinced the number may be further reduced in the near future.
Dr Kris Skwarski, respiratory physician from the Royal Infirmary of Edinburgh, has been leading the interventional bronchology research team for NHS Lothian for the last four years, and has performed about 500 EBUS procedures already.
He said: "EBUS was developed in Japan. The manufacturers, KeyMed Olympus UK, decided that NHS Lothian doctors were sufficiently competent in the use of another ultrasound technique called EUS (Endoscopic Ultrasound) and gave us the task of developing a reference centre for EBUS in the UK."
Dr Skwarski has trained Dr John McCafferty, Consultant Respiratory Physician from St John's Hospital in Livingston. He has also provided background teaching in using the EBUS technique for colleagues from around Scotland, England and from overseas.
Dr Ron Fergusson is NHS Lothian's lead lung cancer clinician. He said: "There are only a handful of centers worldwide with more experience of a technique which I believe will become a standard part of lung cancer management in the future."
"Accurate staging of the extent of lung cancer is vital to plan appropriate treatment and to give the patient and their family a better guide to prognosis. EBUS helps us to plan the correct treatment for our patients and may spare unnecessary operations."
View the article online.
Article written by staff at allmediascotland.com and adapted for the purposes of this newsletter.
Back to Top
|
|
|
|
|
|
|
Want to say something, share something, change something?