MEDICAL IMAGE VIEWING on Google Cloud by I M S

International Medical Solutions (IMS; Mississauga, Canada) will provide Google Cloud account users with the ability to upload, manage, distribute, view, annotate, save, download and delete their medical images in a secure environment.

Similar to Google Drive, the IMS Cloud View will connect directly to any Google Cloud account and enable users to access full fidelity medical images, with no installation required. The underlying imaging technology allows medical professionals to engage in interactive, web-based reviews, on any device, using full fidelity digital imaging and communications in medicine (DICOM) images. IMS also plans to optimize the global reach of Google Cloud Platform and expand its current serverless viewing technology in parallel with its artificial intelligence (AI) and machine learning initiatives.

Features include intuitive imaging tools, hanging protocols, presets, and customized toolbars that facilitate image uploading, viewing, annotation, saving, and exporting. Uploaded studies of interest can be immediately downloaded for instant viewing, with all annotations and markups saved and displayed immediately, and can also be shared with colleagues with a quick email link. A full tool set enables quick content creation, including for educational purposes, such as quiz-style multiple choice, true/false, anatomical, or informative questions alongside full-resolution medical images.

“Clients tell us that they like IMS Cloud View because our technology is the missing piece that completes the viewer value chain. It is simple to use, reliable in all types of network conditions, and gives them the freedom and flexibility to read, assess, mark-up and save, import, share, and send secure links from any device, anytime, anywhere,” said Vittorio Accomazzi, CTO of IMS. “They maintain ownership of their data in Google Cloud and we store it in a DICOM compliant, non-proprietary way. We believe IMS Cloud View and Google Cloud Platform will revolutionize the medical imaging industry.”

Google Cloud Platform is a suite of cloud computing services that provides infrastructure as a service, platform as a service, and serverless computing environments. It runs on the same infrastructure that Google uses internally for its end-user products, such as Google Search and YouTube. Alongside a set of management tools, it provides a series of modular services including computing, data storage, data analytics, and machine learning.

ĐTĐ Type 2:Tương quan bề dày lớp áo trong và độ cứng ĐGM CẢNH QUA ULTRAFAST DOPPLER IMAGING

2D shear-wave elastography diagnoses cirrhosis

By Kate Madden Yee, AuntMinnie.com staff writer

December 19, 2018 -- 2D shear-wave elastography (SWE) is an effective tool for ruling out liver fibrosis or cirrhosis in people with chronic liver disease, German researchers wrote in a study published online December 11 in the Journal of Ultrasound in Medicine.

The findings suggest a less-invasive alternative for these patients, wrote the team led by Dr. Golo Petzold from University Medical Center Göttingen.

"In the treatment and monitoring of patients with chronic liver disease, the diagnosis of liver fibrosis or cirrhosis is of great importance," the researchers wrote. "The detection of liver cirrhosis can be challenging at times; early forms of cirrhosis and advanced fibrosis are especially hard to distinguish by imaging studies. The reference standard for the diagnosis of liver fibrosis (staging) and cirrhosis is liver biopsy. This procedure is invasive, is sometimes painful, and has rare but potentially serious complications."

An increasing number of ultrasound device manufacturers are incorporating shear-wave elastography into their scanners, according to Petzold and colleagues. Their study had three goals:

• Use 2D SWE to determine normal liver stiffness values for healthy subjects and compare them with values in patients with liver disease.
• Assess the influence of age, sex, body mass index, and steatosis on liver stiffness measurement.
• Explore whether it's possible to rule out disease based on cutoff values for histologically confirmed cirrhosis.

The study included 167 subjects enrolled between July 2016 and February 2018. Within this group, 56 had a healthy liver but nonhepatic disease (requiring baseline abdominal ultrasound), 45 had liver cirrhosis, and 66 were healthy volunteers. All participants underwent a baseline 2D SWE ultrasound exam to establish a liver stiffness measurement.

Liver stiffness in the patients with healthy livers but nonhepatic disease did not differ significantly from liver stiffness in the healthy volunteers, the researchers found. Male sex was associated with significantly higher liver stiffness in healthy volunteers; however, age, body mass index, mild steatosis, and nonhepatic morbidities had no significant impact on liver stiffness. Liver stiffness was significantly higher in patients with cirrhosis.

Liver stiffness values on SWE by patient group
	Healthy participants	Healthy liver patients with nonhepatic disease	Patients with cirrhosis
Liver stiffness (kPa)	5.19	4.93	13.29
Minimum liver stiffness (kPa)	3.62	3.49	7.38
Maximum liver stiffness (kPa)	8.33	6.66	19.96

2D SWE is a relatively new ultrasound technique, but it appears to be effective for evaluating liver stiffness and, therefore, ruling out cirrhosis, Petzold and colleagues wrote.

"The liver stiffness measurement in patients with histologically confirmed liver cirrhosis was significantly higher than that in the healthy-liver cohort," they concluded. "Importantly, the reference ranges for the cirrhosis and healthy-liver cohorts did not overlap. ... Therefore, on the basis of our data, we can rule out cirrhosis in patients with normal liver stiffness values, but no cutoff values for cirrhosis can be derived at present."

Ultrasound options abound for diagnosing liver disease

By Kate Madden Yee, AuntMinnie.com staff writer

December 12, 2018 -- When it comes to ultrasound, radiologists have a number of options for effectively diagnosing advanced fibrosis in patients with nonalcoholic fatty liver disease (NAFLD) -- as well as "mapping" liver stiffness and tracking liver cancer treatment, according to research delivered at the RSNA 2018 meeting.

Three presentations described the performance of various ultrasound techniques for liver indications, including shear-wave elastography (SWE), MR elastography (MRE), transient elastography (TE), and contrast-enhanced ultrasound.

Take your pick

Dr. Alessandro Furlan of the University of Pittsburgh and colleagues found that SWE, MRE, and TE are all viable alternatives to liver biopsy for diagnosing advanced fibrosis in patients with NAFLD.

"Since determination of liver fibrosis via biopsy is invasive and associated with significant cost, patient discomfort, and potential risks, several alternative approaches have been developed, including elastography," Furlan told session attendees.

The study included 62 patients, all of whom had biopsy-proven disease. The patients underwent SWE, MRE, and TE within one year of the biopsy; the researchers evaluated each type of imaging exam's performance with area under the receiver operating characteristic (ROC) curve analysis.

The area under the ROC curve for identifying advanced fibrosis was 0.89 for SWE, 0.95 for MRE, and 0.86 for TE; for significant fibrosis, the values were 0.80 for SWE, 0.85 for MRE, and 0.77 for TE. When each modality was compared with the others, there was no statistically significant difference in performance, Furlan said.

"2D shear-wave elastography, MR elastography, and transient elastography are valid alternatives to biopsy for the diagnosis of advanced fibrosis in patients with nonalcoholic fatty liver disease," he concluded.

Fewer biopsies

In a related presentation delivered during the same session, Dr. Rolf Reiter of Charité University Medicine Berlin shared study results suggesting that multifrequency MR elastography (mMRE) is a promising tool for mapping the distribution of fibrosis throughout the liver, which could, in turn, reduce the need for liver biopsy.

Reiter and colleagues evaluated mMRE's diagnostic accuracy by using multifrequency MR elastography in 43 patients with hepatic fibrosis. The study also included a group of 16 healthy people for comparison.

Tomoelastography stiffness maps showed high spatial resolution and anatomical details, allowing for high diagnostic accuracy for staging hepatic fibrosis, Reiter reported.

"Tomoelastography [showed] an excellent diagnostic accuracy for staging hepatic fibrosis," he told session attendees. "[Our work suggests that] mMRE-based tomoelastography might reduce the need for invasive liver biopsies and indicate the distribution of fibrosis within the entire liver."

Find cancer with contrast

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ĐỂ SIÊU ÂM CHẨN ĐOÁN ĐÚNG HẸP ĐỘNG MẠCH THẬN

Abstract

Aim: Renal artery duplex ultrasonography (RDU) is an effective and non-invasive screening test in diagnosing renal artery stenosis. The discordance of results in multiple RDU is common. We aim to evaluate the discordance and the reasons for discordance between diagnoses and measurements from multiple RDU examinations.

Material and method: A retrospective study was performed in 64 examinations of renal arteries from 32 patients that were referred for two or more RDU examinations and renal artery digital subtraction angiography (DSA) within six months, between August 2013 and January 2016. Using DSA as gold standard, we divided the renal arteries into three groups: discordant (one diagnosis of RDU was correct and one was wrong), misdiagnosed (neither RDU diagnosis was correct) and correct (both RDU diagnoses were correct) groups.
We evaluated the discordance and reasons for discordance of diagnoses and measurements from multiple RDU examinations. 

Results: Among 64 renal arteries included in this study, 37 renal arteries had two correct diagnoses, 19 renal arteries had two discordant diagnoses, and eight renal arteries were misdiagnosed twice by RDU. The discordance of peak systolic velocity (PSV), the ratio between PSV in the renal artery with stenosis and PSV in the aorta (RAR), and tardus-parvus waveform measurements were clearly higher in the discordant diagnoses group than in the correctly diagnosed group. The most common reason for a discordant diagnosis was failure in obtaining correct tardus-parvus waveforms of the interlobar artery (26.31%). The
most common reason for misdiagnosis was the presence of an extremely severe stenosis with an atrophic kidney (31.25%). Overall, 87.50% of patients underwent RDU examinations had correct diagnoses of stenosis or occlusion at least once (including location and degree), as confirmed by DSA.

Conclusions: Our study indicates that standard operating procedures and improvements in examination technique by ultrasound doctors could reduce the discordance between multiple tests.