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Welcome to the 38th MEDICA – the world’sbiggest medical trade show – where onceagain the number of exhibitors, as well asvisitors, is predicted to break all previousrecords. Horst Giesen, the project coordinatorof MEDICA, described highlights of this year’sshow, and future plans for the event, in aninterview with Daniela Zimmermann, of
European Hospital, publisher of the annual @MEDICA series,who asked ‘What are the hot topics this year?’HG: Nothing will be presented with a lotof razzle-dazzle. However, it’s one ofMEDICA’s strengths to focus on theongoing development of trends. A pointin case: miniaturisation. There are anumber of innovations, as devices arebecoming ever smaller and better.
Point-of-care testing is another bigissue where we see a constant flow ofclinical enhancements. Today, manyprocedures and measurements that tra-ditionally had to be performed in thelaboratory can be done at the bedside –with results instantly available. Is the integration of such data into
the electronic patient record (EPR)
and hospital information system
(HIS) still a big focus?
Uncover the new generation of clinicalinformation systems !
S P E C I A L I S S U E : M E D I C A L , T E C H N I C A L , P H A R M A C E U T I C A L , I N D U S T R I A L N E W S & M U C H M O R E
EUROPEAN HOSPITAL
N O V E M B E R 2 0 0 6
DUSSELDORF WEDNESDAY 15 NOVEMBER
The heart of healthcarebeats in Dusseldorf
Horst Giesen
continued on page 2
Very big – particularly in Germanhealthcare, where the focus is on theelectronic health card. At the show,several companies will demonstratehow that card works and explore itspotential. We have scheduled the spe-cial show MEDICA.Media, which willalso deal with the subject. Technically,these cards are available, but the differ-ent stakeholders have to agree on theways they will be used. This is a very German issue.
Indeed! But the electronic health card,I mean the software, and the techno-logical know-how behind it, can beexported and thus presents majorinternational market potential.
For better operating results:� iLED surgical lights with integrated
camera system: for the best possible view
� MARS operating table – the new generation:
flexible, mobile and strong
TRUMPF will be exhibiting these and many other
innovative products for operations and intensive
medicine at Medica 2006.
For the first time at Medica:
The TRUMPF communication forum � Lectures and discussions with
users and specialists
� Directly at the TRUMPF
exhibition stand
I N N O V A T I O N S
F O R P A T I E N T C A R E
TRUMPF Medizin Systeme Phone +49 (0) 89 / 8 09 07-0
www.trumpf-med.com
Intelligent Products –Integrated ConceptsMedica 2006 · Hall 13 · Stand A 42
Intelligent Products –Integrated Concepts
You can spend your whole life without ever seeing a single eclipse.
Fortunately, our ECLIPSE® is conveniently packaged in boxes of 100.From first contact you’ll agree, Eclipse Probe Covers provideunmatched quality and economy.
• Soft, pliable, latex-free polyethylene film for endocavity ultrasound• Conveniently pre-gelled with Aquasonic® 100
Ultrasound Transmission Gel• Cost-effective, economically priced, and packed 100 per box• Disposable, for single use• One size fits most endocavity ultrasound probes
Parker Laboratories, Inc.286 Eldridge Road • Fairfield, NJ 07004 • Tel: 973-276-9500 • Fax: 973-276-9510 • www.parkerlabs.com • ISO 13485:2003
ECLIPSEP R O B E C O V E R
®
Only Eclipse Probe Covers are
conveniently pre-gelled inside with
Aquasonic® 100 Ultrasound Transmission Gel,
the world standard for medical ultrasound.
VISIT US AT MEDICA 2006 • HALL 9 • STAND D41
spirit of excellence
www.richard-wolf.com
You are welcome at our stand
Medical
Choose Sony as your partner and you’ll benefit from direct access to the
broadest portfolio of high quality medical grade products. Complementing
imaging solutions from today’s leading modality manufacturers, Sony products
make it possible to capture, view, store, print and share images from a range
of modalities with greater accuracy and detail than ever before. What’s
more, they’re designed to complement real world workflow with superb
performance and reliability. But that’s only half the story. When you choose
Sony you’re benefiting directly from more than 25 years of continuous evolution
in developing superb professional medical products… and a very healthy
commitment to reinforce the success of your own business.
Doesn’t that sound like a relationship everyone can believe in?
www.sonybiz.net/medica
More Detail. More Care.
Sony is a trademark of the Sony Corporation, Japan.
Medical Solutions from Sony Medica 2006November 15-18th, Düsseldorf Join us at Stand A21 in Hall 15
3
Thursday’s edition of2006@MEDICA
focuses on rescueand emergency care,including national andinternational disasterservices planning and
much else.Other hot topics
include updates onhospital hygiene.
Meet us at MEDICA! Hall 7 Stand E15 The European Hospital team will be happy to hear about your research, productsR&D and/or trials and launches, hospital management issues, or any other aspectsof your work, so that we can discuss your editorial and/or advertising needs. (Youcan also locate our contact details on page 14).
Our publications are distributed to Europe’s leading medical and hospitaladministrative personnel, making EUROPEAN HOSPITAL the leading pan-Europeanmedical and healthcare journal.
We also publish the hospital architecture/design magazine D4 Health and the@MEDICA series.
During this year’s show, three special 2006@MEDICA editions will be distributed -on Wednesday, Thursday and Friday – so don’t miss any! If you did not receive yourfree copies at the entrance of Messe Dusseldorf, simply visit our stand.
If you miss us at MEDICA, we will also be at RSNA 2006, held later this month inChicago, USA. (South building. Hall A, stand 1008).
So, enjoy your visit – and let’s meet!
Welcome to the 38th MEDICA – the world’sbiggest medical trade show – where onceagain the number of exhibitors, as well asvisitors, is predicted to break all previousrecords. Horst Giesen, the project coordinatorof MEDICA, described highlights of this year’sshow, and future plans for the event, in aninterview with Daniela Zimmermann, of
European Hospital, publisher of the annual @MEDICA series,who asked ‘What are the hot topics this year?’HG: Nothing will be presented with a lotof razzle-dazzle. However, it’s one ofMEDICA’s strengths to focus on theongoing development of trends. A pointin case: miniaturisation. There are anumber of innovations, as devices arebecoming ever smaller and better.
Point-of-care testing is another bigissue where we see a constant flow ofclinical enhancements. Today, manyprocedures and measurements that tra-ditionally had to be performed in thelaboratory can be done at the bedside –with results instantly available. Is the integration of such data into
the electronic patient record (EPR)
and hospital information system
(HIS) still a big focus?
Uncover the new generation of clinicalinformation systems !
S P E C I A L I S S U E : M E D I C A L , T E C H N I C A L , P H A R M A C E U T I C A L , I N D U S T R I A L N E W S & M U C H M O R E
EUROPEAN HOSPITAL
N O V E M B E R 2 0 0 6
DUSSELDORF WEDNESDAY 15 NOVEMBER
The heart of healthcarebeats in Dusseldorf
Horst Giesen
continued on page 2
Very big – particularly in Germanhealthcare, where the focus is on theelectronic health card. At the show,several companies will demonstratehow that card works and explore itspotential. We have scheduled the spe-cial show MEDICA.Media, which willalso deal with the subject. Technically,these cards are available, but the differ-ent stakeholders have to agree on theways they will be used. This is a very German issue.
Indeed! But the electronic health card,I mean the software, and the techno-logical know-how behind it, can beexported and thus presents majorinternational market potential.
For better operating results:� iLED surgical lights with integrated
camera system: for the best possible view
� MARS operating table – the new generation:
flexible, mobile and strong
TRUMPF will be exhibiting these and many other
innovative products for operations and intensive
medicine at Medica 2006.
For the first time at Medica:
The TRUMPF communication forum � Lectures and discussions with
users and specialists
� Directly at the TRUMPF
exhibition stand
I N N O V A T I O N S
F O R P A T I E N T C A R E
TRUMPF Medizin Systeme Phone +49 (0) 89 / 8 09 07-0
www.trumpf-med.com
Intelligent Products –Integrated ConceptsMedica 2006 · Hall 13 · Stand A 42
Intelligent Products –Integrated Concepts
You can spend your whole life without ever seeing a single eclipse.
Fortunately, our ECLIPSE® is conveniently packaged in boxes of 100.From first contact you’ll agree, Eclipse Probe Covers provideunmatched quality and economy.
• Soft, pliable, latex-free polyethylene film for endocavity ultrasound• Conveniently pre-gelled with Aquasonic® 100
Ultrasound Transmission Gel• Cost-effective, economically priced, and packed 100 per box• Disposable, for single use• One size fits most endocavity ultrasound probes
Parker Laboratories, Inc.286 Eldridge Road • Fairfield, NJ 07004 • Tel: 973-276-9500 • Fax: 973-276-9510 • www.parkerlabs.com • ISO 13485:2003
ECLIPSEP R O B E C O V E R
®
Only Eclipse Probe Covers are
conveniently pre-gelled inside with
Aquasonic® 100 Ultrasound Transmission Gel,
the world standard for medical ultrasound.
VISIT US AT MEDICA 2006 • HALL 9 • STAND D41
spirit of excellence
www.richard-wolf.com
You are welcome at our stand
Guidelinesupdated for
high-risk women
News & Management . . 1-5Respiratory &intensive care . . . . . . . . 6-11Radiology . . . . . . . . . . .12-21Cardiology . . . . . . . . . .22-24Surgery &orthopaedics . . . . . . . .25-27Laboratory &hygiene . . . . . . . . . . . .28-29Oncology . . . . . . . . . . .30-31Innovations . . . . . . . . .32-33Global events . . . . . . . . . .34Advertisers index . . . . . . .35
contents
6-11Respiratory &Intensive Care
• Brain controlsventilation
• Measuringwithin the lung
• TB Update
25-27Orthopaedics
• Yale-method hipreplacement
• Hip structureanalysis software
•Inorganic bonegrafting
T H E E U R O P E A N F O R U M F O R T H O S E I N T H E B U S I N E S S O F M A K I N G H E A L T H C A R E W O R K
CO
URT
ESY
OF
SEC
TRA
France: Breast cancer screening going digital?Lithuania’s new programme. See pages 30-31
Report: Brenda Marsh
25 October – The National Institutefor Health and Clinical Excellence(NICE) – the independentorganisation responsible forproviding national guidance on theappropriate treatment and care ofpeople with specific diseases andconditions within the NationalHealth Service (NHS) - has updatedits familial breast cancer guideline torecommend annual magneticresonance scanning (MRI) for breastcancer screening of women agedbetween 20-49 years who are at highrisk of breast cancer. These includethe country’s estimated 1% of youngwomen who carry either of therecently discovered high-risk genesBRCA1 or BRCA2, and thereforeface an up to 85% breast cancer risk(the average woman faces an 11%risk).
A country-wide study, by theInstitute of Cancer Research(published in the Lancet in May2005) found that MRI identified77% of tumours in younger womenat high genetic risk - compared withjust 40% using X-ray mammography(XRM). A combination of MRI and
The review, carried out by the NordicCochrane Centre and published by theCochrane Library, concludes thatwhilst screening is likely to reducebreast cancer mortality, it is by afairly low percentage, and it can alsolead to over-diagnosis and over-treatment. For every 2,000 womenscreened over a 10-year period, onewould have life prolonged. But, thereport adds, 10 healthy women willbe treated unnecessarily, because theyhave slow-growing cancers that mightnever have affected them if they werenot identified during screening.
Dr Peter Goezsche, director of theCentre said that, because the risk forharm is so big, if he was a 50-year-oldwoman he would decline an offer ofscreening, ‘…I would not participatein this lottery’.
The review has led Michael Baum,Professor Emeritus of Surgery, VisitingProfessor of Medical Humanities atUniversity College London, andpioneer of the UK’s screeningprogramme, to question whether theNHS breast screen programme shouldbe abandoned, and to call for aninvestigation by NICE.
A new biodegradable solution hasstopped bleeding in animals’ woundswithin seconds, according toresearchers reporting in the journalNanomedicine. Lead researcher DrRutledge Ellis-Behnke, at theMassachusetts Institute of Technology,USA, who worked on the developmentwith teams in the USA and theUniversity of Hong Kong, said thenanofibre barrier it forms stops bleed-ing in under 15 seconds, which couldrevolutionise bleeding control - andeven reduce operation times by 50%.
When the solution, composed ofpeptide, comes in contact with awound, they self-assemble into a gel,which does not harm cells it contacts,but forms such an effective seal, thateven when excess gel is removed thewound is still sealed. Precisely howthis solution works is not clear. Woundsealing is too quick to result from clot-ting, which take about 1-2 minutes toform. Nor was any platelet aggrega-tion at the interface of the materialand wound site observed. Theresearchers believe the peptides inter-act with the extra-cellular matrix sur-rounding the cells. Thus, when aninjury heals, the gel gradually breaksdown into amino acids, which canhelp cells to repair tissue.
XRM screening enabled the detectionof 94% of tumours. MRI provedparticularly effective for womencarrying the BRCA1 gene mutation -detecting 92% of tumours, whereasXRM only detected 23%.
About 40% of women at high riskopt to have mastectomies rather thanface the risk of developing cancer.This has meant removing healthybreasts. Although about 10 timemore expensive than the standardmammograms currently used, anannual MRI scanning programme forwomen in this high risk categorycould alter that radical choice ofsurgery.
Although in the USA, high riskwomen are routinely offered MRIscans, in the UK, women aged 40+with high-risk genes are currently onlyoffered mammography, and the arrivalof the NICE updated screeningguideline does not necessarily herald achange in practice. Health authoritiesmust follow NICE rulings on the useof pharmaceuticals, but NICEguidelines on procedures are notmandatory; they are viewed as ‘bestpractice’ standards. Thus the adoptionof MRI scanning for the high-riskwomen will remain a decision of thehealthcare authorities, which in turnmust consider budgetary restraints.
* In the NICE guideline, all theother recommendations on howhealth professionals should identifyand care for women at risk ofdeveloping breast cancer due tofamilial breast cancer remain thesame.
Value of screening questionedA new major review of studies onbreast cancer screening, whichinvolved half a million women, hascaused considerable stir in the UK.
World’s first full-facetransplant
The ethics committee of the UK’ sNational Health Service (NHS) has clearedthe way for the world’s first full facetransplant, raising the hopes of around 30people who are prepared to undergo theprocedure.
Plastic surgeon Peter Butler and thetransplantation team at London’s RoyalFree Hospital, have studied the possibilityof total face replacement surgery for sev-eral years. Now, following the commit-tee’s approval, he said the most impor-tant part of the process is now beginning:selection of the patients. Many of thecandidates have already suffered up to 70reconstructive surgeries. Only four will beselected for a full-face transplant. Part oftheir assessment includes their ability tocope psychologically.
Although during surgery on the donor,the skin, underlying fat, eight blood ves-sels, four arteries and four veins will beremoved, for reconnection to the recipi-ent, computer modelling, carried out byPeter Butler, has shown that, due to dif-ferent facial shape and bone structure,the patient will not look like the donor.
The first operation is expected to takeplace ‘within months’, the others at sixmonth intervals.
Solution revolution for bleeding control
Left: Dr Rutledge Ellis-Behnke with ProfessorGerald Schneider, with monitor showingtransected liver, sealed by the gel
PHO
TO: D
ON
NA
CO
VEN
EY/M
IT
The new solution has been applied tovarious kinds of tissue, including skin,brain, liver, intestine, and spinal cord,in almost all cases immediately stop-ping bleeding.
No immune response was observedin animal tests. The researchers alsocould find no prion-like substances, orfibril tangles, after the material hadbeen implanted in the brain for up tosix months.
Other interesting aspects are that thisdiscovery was accidental; it occurredduring their investigation of whetherpeptide solutions can create a self-assembled scaffold for the re-growth ofnerve fibres in animal brains - whichhas helped to partially restore eyesightin animals with a severed visual tract.
No human trials have been under-taken.
V O L 1 5 I S S U E 5 / 0 6 O C T O B E R / N O V E M B E R 2 0 0 6NICE recommends annual MRIscreenings for breast cancer
12-21Radiology
• RSNA Chicago• Imaging
developments• Neuroradiology
• US foetalmonitoring
28 Lab &Pharma
• Automatedsystems
• Moleculardiagnostics
• Drug/genetherapies
MyLabWorldMyLab50
ESAOTE Biomedica Deutschland GmbH
Ludwigstr. 47 . D-85399 Hallbergmoos
Fon +49-(0)180-5 372683 . Fax +49-(0)811-99 86 49 20
www.esaote.de . [email protected]
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INNOVATION in CARDIAC
DIAGNOSIS at your Hands
Please visit
us at Medica,
Düsseldorf,
15th
-18th
Nov. 06,
booth 9A22
2006@MEDICA – Tomorrow!
What are the major international
issues at MEDICA 2006?
The international character of the tradeshow has prompted the DeutscheKrankenhaustag, for the first time, tolook into questions of European con-cern. Under the general heading ‘Com-petition and Performance Results –What the Future holds for Hospitals’ anexchange of information and experi-ence on a European level will be pro-moted.Would you give us some MEDICA
statistics?
The number of exhibitors has increasedagain, compared with last year: we have4,200 exhibitors and 60% are non-Ger-man. Although we are completelybooked, we were able to optimise theset-up and division of available space toaccommodate even more exhibitors.However, there is still a waiting list.With its huge growth and demand
for space, might you plan to move
MEDICA?
MEDICA is a product of Messe Dussel-dorf and certainly won’t take place any-where else. The city of Dusseldorf isthe majority owner of Messe Dussel-dorf and thus is eager to host the world-wide largest medical trade show. Butquite obviously, there are other eco-nomic factors, for example the factthat the trade shows in general, andMEDICA in particular, generate incomefor hotels and restaurants, retailers andothers in this city and the entire region.We have a certain obligation towardsthe location Dusseldorf.
In terms of space, we are currentlybuilding another hall, 8 B, to be com-pleted by September 2007. It willaccommodate 35–400 additionalexhibitors, so next year we’ll grow,along with our exhibitors. Any other plans?
Yes, we will take a closer look at theexhibitors, to check whether they pre-sent real medical products – we will bemore selective. Consequently, we haveto change a few things in the productscatalogue. However, this doesn’t meanwe’ll weed out certain product seg-ments – the segments are appropriate –but we have noticed that, upon registra-tion, exhibitors classify their productsincorrectly and that some of thoseproducts do not fit in the MEDICA port-folio. We will look at this more closely,and here, we rely on the industry asso-ciations to help us identify exhibitorswho do not fit into our show concept.As its organiser for 16 years, do
you still look forward to this
event?
Very much so! I’m impressed that morethan 130,000 visitors from over 100countries and 4,200 exhibitors withabout 26,000 staff from 62 countriescome here to meet, do business,exchange ideas and learn from oneanother. For us, as organisers, this is awonderful confirmation that our workover the years has been, and continuesto be, successful. We can proudlyclaim: For four days every year, theheart of healthcare beats in Dusseldorf.
continued from page 1
4
H O S P I T A L M A N A G E M E N T
UK – Speaking at the first NationalHealth Service (NHS) SecurityManagement Professionalsconference in November, RosieWinterton, the country’s HealthMinister, said the number of NHSstaff who were physically assaultedin England has reduced. Statisticscollected by the NHS SecurityManagement Service (NHS SMS),show a fall of 1,690 in 2005 – asignificant achievement, sinceviolence and abuse had increasedyear-on-year until 2003, when theNHS SMS was set up. In addition,the number of people prosecutedfor assaulting NHS staff in Englandalso increased by 12% in the lastyear, from 759 to 850.
CONGRESSES10:00 – 13:00 hrs. 1st floor, room 4CCase-management in the hospital andsurgery – new challenges and tasksfor doctorsModeration: Hans-Dieter Falkenberg(Munich); Ralph Höll (Munich)Ref.: Gabi Schneider, Rösrath
10:00 – 13:00 hrs. 1st floor, room 17Cardiac imaging update 2006Moderation: Prof. Georg Sabin (Essen);Prof. Raimund Erbel (Essen).Organiser: Medizinische GesellschaftEssen
Clinical imagingProf. Andreas Mügge (Bochum)Myocardium at risk – ischaemiadiagnostics with MRI: dobutaminestress MR versus adenosine MRperfusion.Dr Peter Hunold (Essen)Diagnostics for cardiac nuclearmedicine – now obsolete? Prof. Rainer Zimmermann, Pforzheim
12:00 hrs. Medica meet IT. Hall 15,stand G 48Interoperability. IT networks inhospitals – underestimated risksDavid Kibilka, Head of IT-ManagementSystems, DS Data Systems GmbH;Ludger Witte – responsible forElectronic Data Processing, St-Marien-Krankenhaus Ahaus-Vreden GmbH
13:15 – 14:00 hrs. CCD South, room 2Advances in catheter therapy at theKHK Prof. Hartmut Gülker (Wuppertal)Moderation: Prof. Ernst-Gerhard Loch(Wiesbaden)(This lunchtime symposium includessnacks)
14:30 – 17:30 hrs. 1st floor, room 16The Diseased Kidney – Dialysis ortransplantModeration. Prof. Christoph J Olbricht(Stuttgart)
MEDIA BRIEFINGS14:00 hrs. Hall 12, stand E 17New products for large-scaledisinfection & other innovationsAmong the speakers: Dr Markus Miele,of Miele & Cie. KG, Gütersloh
15:30 hrs. North entrance, room 201Alternative finance solutions inhealthcare – the way to higher processefficiencySiemens Financial Services (Munich)
Today’s MEDICAcongresses and
briefings
THE EU’S 30 BILLION HEALTHCARE LOSSESFraud and corruption network protects 210 million citizensSpain – Speaking at the 3 rd EuropeanHealthcare Fraud and Corruption Con-ference (EHFCN), Jim Gee, EHFCNdirector general, reminded delegatesthat this is the first organisation setup to tackle this problem acrossEurope. 22 organisations, represent-ing 14 countries and 210 million Euro-pean citizens, joined the network inthe last year. Membership is alsobeing considered by 37 organisationsfrom 19 countries and, if they join, hesaid the EHFCN would become evenmore ‘influential and powerful’.
He particularly praised work under-taken by the Ministry of Health inPoland, and the Caisse Nationale del’Assurance Maladie (CNAMTS) inFrance, which set up its own FraudPrevention and Litigation Directoratethis year; it provides a ‘road map’ forfuture success in tackling the prob-lem, he said.
Waiting for fraud to happen will onlylead to further losses and reducedstandards of care, he added. ‘Thiscould lead to patients being sick forlonger, and in some cases, patients
dying unnecessarily because they donot receive the care they need.’
In Europe, estimates of healthcarelosses due to fraud are at least €30 bil-lion annually. He said those who havealready faced this problem have gainedmore money for healthcare provision. InEngland and Wales, after the NationalHealth Service (NHS) began taking mea-sures to counteract the problem sixyears ago, losses were reduced by upto 55% saving €1 billion.
Speakers included leading figures inhealthcare and law enforcement agen-
cies from Europe and beyond, for exam-ple Jaclyn Zappacosta, Legal Attaché atthe FBI’s Healthcare Fraud Unit andDora Akumyili of Nigeria’s NationalFood Agency for Food and Drugs Admin-istration.
Jim Gee has now given up his leader-ship of the network to focus on health-care fraud and corruption in Englandand Wales.
Marieke Koken, director of claim con-trol at Zorgverzekeraars Nederland (ZN),a sector organisation for the Dutchhealthcare insurers, and new EHFCNDirector General, said more criminalsmust be found and punished. The net-
work is to develop a training databaseand common training syllabus for allEFCN counter fraud professionals,she said. A manual, due out in 2007,will include detection and investiga-tion methods, supported by casestudies showing their success aroundEurope.
The new EHFCN Executive Commit-tee includes experts in corruption pre-vention, counter fraud and security,labour and welfare, health and labourinsurance and healthcare insurance.
During a month-long Fraud and Cor-ruption Awareness Campaign, thisNovember, one of the aims is for net-work members to visit hospitals, forexample, to talk with staff andpatients.Details: www.ehfcn.org
Drunken abuse and violenceagainst hospital staff
PROSECUTIONS UP, NUMBERS DOWN
‘By giving the NHS the power toremove a potential threat, theoffence would help reduce violentattacks on staff,’ she said. ‘This,alongside an increase inprosecutions, conflict resolutiontraining for over 250,000 staff andour close working relationship withthe Association of Chief PoliceOfficers, means we can win the waragainst these violent offenders.’
Richard Hampton, Head of theNHS Security Management Service,said:
‘The statistics are the mostaccurate on the issue in the historyof the NHS. They show that thevery hard work that has beenundertaken in the last three years is
The statistics record 58,695physical assaults against NHS staffin England, 1,690 fewer than 2004-5,and one for every 23 staff members,down from 22 last year.Figures include:● 1,104 assaults against ambulancestaff, down 229 from 2005 (oneassault per 29 staff members)● 11,100 assaults against staff fromacute and foundation hospitals, 342more than last year (one assault per67 staff members)● 5,145 assaults against staff atprimary care trusts, 47 fewer thanlast year (one assault per 68 staffmembers● 41,345 assaults were againstmental health and learning disabilitystaff, 1,752 fewer than last year (oneassault per five staff members)
‘It is totally unacceptable thatNHS staff should face violence andaggression in the course of their job.Thankfully, these statistics showthat the tide is turning and we arefinally seeing a reduction in thenumber of assaults. However thisdoes not mean we can rest on ourlaurels. There are still too manyattacks on staff and for this reason,following our public consultation,we are proposing to make anti-social and nuisance behaviour onNHS premises a criminal offence,’Rosie Winterton announced.
In response to a publicconsultation on nuisance behaviourin hospitals, the country’sDepartment of Health has proposedto make nuisance and anti-socialbehaviour in hospitals a criminaloffence, with fines of up to £1,000,and the power to remove theoffenders from NHS premises.Responses were overwhelminglypositive showing that the NHS andthe public support measures totackle nuisance and abusivebehaviour before it becomes violent.
beginning to bear fruit, makingpatients and staff safer. Since theNHS Security Management Servicewas created in 2003, there havebeen fewer physical assaults, a 16-fold increase in the number ofprosecutions and a greaterawareness amongst staff that actionis being taken. We hope NHS staffwill feel more confident inreporting every incident.’
However, he added: ‘Most peoplerespect NHS staff and would neverdream of attacking them, but theNHS SMS will continue to strive tocreate a safer and more secureenvironment for staff and patients.’
The full response to theconsultation is available atwww.dh.gov.uk/consultations
New protective rights for hospitalsRoyal Bolton Hospital has one ofthe busiest accident and emergency(A&E) departments in the NorthWest, treating between 300–320patients daily, which amounts toaround 100,000 people annually.
Between April and Septemberthis year, 40 people were escortedfrom the hospital’s A&E by securitystaff due to unacceptable behaviour(for example, spitting, shouting,swearing and being disruptive orabusive) towards staff. In addition,during that period 41 peopleverbally abused A&E and securitystaff. ‘No one should have to putup with this kind of behaviour intheir workplace. It also causesdistress in other patients andvisitors in the department. Staff donot always report incidents ofaggressive behaviour towards them– many feel it is part of the job –but this is unacceptable and it hasto stop,’ said Dr Richard Parris,consultant in accident andemergency medicine at thehospital.
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c o m p a n y n e w sH O S P I T A L M A N A G E M E N T
Medical and financial assessmentof new technologies in hospitalsFrederik L Giesel MD MBA, is asenior resident in radiology at theGerman Cancer Research Centre,Heidelberg, Germany, and recentlya visiting lecturer at the Universityof Sheffield. His research focus ison pharmacokinetic and molecularimaging. He holds several patentsfor contrast media, undertakes var-ious clinical trials, and has broadexpertise in industrial cooperation.
He has considerable internat-ional experience, which includesmedical studies in Germany, Cana-da, the USA and the UK, and herecently finished a course in inter-national healthcare management inthe executive MBA programme atHfB (Business School of Finance &Management) in cooperation withNCH (Nations Health CareerSchool of management). His MBAthesis focused on medical andfinancial assessment of new tech-nologies in hospitals. The resultsof this work - of which he presentsa short summary* – will be present-ed at the Dubai Hospital Congress
in 2007 (IMDIHF Dubai 2007).Through the executive MBA
programme, Dr Giesel widened his expertise to include manage-ment and financial assessment. He is already involved in costanalysis and pricing for ultrasounddiagnostic procedures, for the Ger-man Association of Ultrasound(DEGUM) and is also developing abusiness plan for a private MRIunit.
SummaryHealthcare and the increaseddemands on technology raise thequestion of the investment andrunning costs associated with aparticular technological device andwhether new technology mightimprove processes and work effi-ciency (cost per unit). Today, thefocus is not only on quality anddiagnostic or therapeutic improve-ment to the patients. There arealso important financial aspectsinvolved, and one of the mainissues is process management andefficiency.
This work examined the crucialissue of workflow in drug purchas-ing and delivery in a hospital envi-ronment, which is still causingdrug distribution errors and there-fore critical drug adverse events(~4–5%). Many weak sub-process-es were identified through a com-parison with an automatedprocess. The latter can make cer-tain sub-processes redundant,such as revaluation of the pickinglist or decentralized stockage,which holds a lot of unutilisedvalue (~0.5–1 million euros, 600-bedhospital).
The investigation began by tak-ing a closer look into the workflowof medical drug delivery in hospi-tals, focusing on characterization(responsibility and time) in theprocess commonly used in hospi-tals and comparing these charac-teristics with the utilization of anautomated drug dispenser system.In an evaluation of the processfrom drug prescription to adminis-tration, 11 steps could be identi-fied. By using the ADD system, fiveout of 11 steps could be eliminated(via drug storage centralizationand an IT prescription system).
The total process time was esti-mated to be 29.1 hours for the con-ventional approach, whereas,using ADD, only 19.1 hours wereestimated, which means the totalprocess time by human resourcescould be reduced by about 34%.After the process characterizationby time, value and cost was elabo-rated, the total investment and
amortization rate were investigat-ed for an automated drug dis-penser system. For a 600–bed hos-pital the total investment cost wasestimated to be around 1.0 millioneuros, and the break- even after a100% roll out was estimated afterthe third year.
This investigation indicates thatan ADD system improves not only
the process quality in the hospitalusing newest technology (unitdose and bar coding) and there-fore reduces human errors in drugdistribution. In addition, with thisnew technology, costs (reducingtime and human resources) can besaved and break-even is reachedafter just three years of initialinvestment.
* Giesel FL (German Cancer
Research Centre, Heidelberg, and the
HfB-Business School of Finance &
Management, Frankfurt), Rius M
(German Cancer Research Centre,
Heidelberg), Sibbel R (HfB-Business
School of Finance & Management,
Frankfurt, Germany); Grosch S
(Swisslog, Switzerland); Stroud M
(BMI Health Care, London, UK),
Kauczor HU (German Cancer
Research Centre, Heidelberg), Wocher
J (Kameda Medical Centre, Kameda,
Japan) and Breitenbach F (EDAG
Engineering + Design AG, Business
Unit Clinic, Fulda, Germany)
Frederik Giesel
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O R T H O P A E D I C S
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UK – Around 10 million peoplesuffer from musculoskeletalailments in England alone.Currently the route to treatmentruns between the local generalpractitioner (GP) and the specialist,with a maximum wait of up to 18weeks from the GP’s referral tohospital treatment.
The new Musculoskeletal
Services Framework (MSF),announced by Health Minister AndyBurnham this November, willprovide the country’s NationalHealth Service (NHS) withguidance to help improve servicesby providing faster, better andmore convenient treatment formusculoskeletal patients. It showshow the health service can use awider range of health professionals,including physiotherapists, nursesand pharmacists, as well as GPsand hospital consultants, and how,by using a range of professionals,patients will receive fastertreatment, closer to their ownhome rather than have to travelto hospital.
The MFS is a real partnershipsuccess, as it has been developedby specialists working withstakeholders and so has theendorsement of the profession, saidAndy Burnham, adding thatpatients with long-term conditions,such as arthritis and back pain,prefer treatment close to home,rather than having to travel to andfrom a hospital. ‘The new guidancewill mean that this will be possiblefor more patients, all supported byhigh quality hospital based serviceswhere they are needed,’ he said. ‘Itwill also mean faster treatment forpatients. Implementing the
BONE SUPPORT STUDY IS UNDERWAYCerament Spine Support,
designed by the medical technol-
ogy company BoneSupport to
treat osteoporotic vertebral com-
pression fractures, has achieved
full patient enrolment in an
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cial quality of life outcome for
the patients.
The study, being carried out at
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40 patients aged between 50-90
years (average: 70 years).
‘In Europe, osteoporotic verte-
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MDCT IMAGING TECHNIQUETO EVALUATE BONE HEALINGMulti-detector computed tomogra-phy (MDCT), using high-quality 2-Dformatting, is highly recommendedas the primary imaging technique toevaluate bone healing, according toa study by radiologists at the Med-ical University of Vienna, Austria.
The study included 43 patientswith histories of fractures, arthrode-sis (joint fusion) or spinal fusionswho had undergone MDCT and con-ventional radiography to evaluatebone healing.
Two musculoskeletal radiologistsanalysed multiplanar reconstructions
and radiographs in a consensusinterpretation. Their results showedno evidence of bone bridging in 14patients. 23 patients showed evi-dence of partial fusion, and sixshowed complete fusion. In 27patients (63%), MDCT and digitalradiography were concordant interms of the extent of bone healing,while in 16 patients (37%) theresults were not concordant. Ineight patients digital radiographsunderestimated the extent of bonehealing, while in another eightpatients they overestimated the
degree of fusion. ‘Most cases weredealing with bone healing afterspondylodiscitis, fractures orarthrodesis,’ said Christian R KrestanMD, the study’s lead author. ‘Howev-er, no scientific data were availableconcerning the value of MDCT inbone healing compared with radi-ographs, which had been used fordecades in this indication.
’The study results have a consider-able impact on orthopaedic patientsand lead to a substantial improve-ment in patient care,’ he added. ‘Theexact diagnosis or exclusion of bonehealing provides a basis for decisionslike mobilisation or immobilisationand even repeated surgery in thesepatients.’Source: The American Roentgen RaySociety (ARRS)
Treatment of orthopaedicpatients to accelerate
framework will enable them to beseen sooner by a health professionalwithout the need to wait for aconsultation with a surgeon.However, patients who still need tosee a surgeon will do so.’
The Our Health Our Care Our
Say White Paper, produced by theDepartment of Health, set out avision to provide people with goodquality care in the communitieswhere they live. It identifiedorthopaedics as one of the sixspecialties where the greatestprogress could be made and theevaluation of pilot sites is alreadyunderway. The Department ofHealth is working closely with agroup of key NHS stakeholders toco-ordinate these pilots with theongoing work to tackle thechallenges of meeting the 18-weektarget in orthopaedics. The MSF iscentral to this work.
In March, this year, the PennineMusculoskeletal MedicinePartnership, a Specialist PersonalMedical Services partnership was
commissioned by Oldham PCT toprovide a comprehensive service tothe population of Oldham inRheumatology, Orthopaedics andChronic Pain.
The pilot study is designed toscreen GP referrals for secondarycare, managing those patients whodid not need to see a consultantrheumatologist, and ensuringpatients who were referred on tosecondary care were fullyinvestigated before seeing theconsultant. The service is managedby the PCT and clinically led by DrAlan Nye (GPSI Rheumatology) andAnne Browne (Nurse ConsultantRheumatology) with input fromspecialist physiotherapy, liaisonpsychiatry and osteoporosis nursespecialist.
The service has been highlysuccessful with 70% diversion of GPreferrals away from secondary care,with high levels of patient, staff andGP satisfaction, the Department ofHealth reports. Guidance details: www.dh.gov.uk
It should allow us to have the
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c o m p a n y n e w sO N C O L O G Y
Discovered: a new genetic route to skin cancer
UK – A complex chain ofmolecular triggers involved in thedevelopment of malignantmelanoma, the deadliest form ofskin cancer, has been unravelled,according to a study carried out byscientists at the Institute of CancerResearch (ICR) and published inCancer Research*.
Most skin cancers are caused bydamage to genes from UV(ultraviolet) rays in sunlight.Melanoma occurs whenmelanocytes, the cells in the skinthat protect us from UV light, growuncontrollably. Knowing the wayin which the sun-damaged genescause skin cancer could lead tothe development of drugs to targetpeople whose cancer developed inthis way.
The research team discoveredhow a damaged version of a genecalled RAS stimulates the growthof about 15–20 % of malignantmelanomas. The growth andbehaviour of melanocytes arecontrolled by many differentfactors. Crucially, faults in theRAF genes are important becausethey send signals to the cell tellingit to grow. Scientists already knowthat faults in the B-RAF gene areassociated with around 50 –70% ofmelanomas.
However, until now it was not
known how a growth signal wasgenerated in the melanomas inwhich B-RAF is not mutated. Thisnew research reveals that faults inthe RAS gene activate anotherform of RAF, C-RAF, which thensubstitutes for B-RAF and socontributes to the development ofmelanoma.
Lead researcher ProfessorRichard Marais (left), at the ICR,said: ‘We knew that RAS is
mutated in up to a fifth ofmelanoma cases, but did not knowhow it was able to drive thegrowth of cancer cells. Thisresearch found that RAS activatesone of the RAF proteins and fromour previous work, we knew thata different RAF protein wasimplicated in the development ofmost other melanomas. Knowingmore about the behaviour of allthe different pathways involved in
the development of melanomacould have implications for drugtargeting. This discovery has thepotential to enable us to developtargeted treatments to repair thisparticular fault and reverse theeffects of the disease.’
Professor John Toy, CancerResearch UK’s medical director,said: ‘These findings will helpimprove our generalunderstanding of how melanomas
develop and grow out of control.Finding new treatments toeffectively target melanoma is ofcritical importance becausecases of the disease are set totreble over the next thirty years.’* In melanoma RAS mutationsare accompanied by switchingsignalling from B-RAF to C-RAFand disrupted cAMP signalling.Dumaz et al. (2006). CancerResearch Vol 66 Issue 19.
Malignant melanoma About 8,000 cases of malignantmelanoma are diagnosed in the UKannually, and it causes almost1,800 deaths each year there. Thedisease usually develops in cells inthe skin’s outer layer, with first vis-ible signs possibly a change in thenormal look or feel of a mole.
Although the risk of this diseaseincreases with age, it is one of thefew cancers to affect young adultsand is the third most common can-cer amongst 15 –39 year olds.
More women than men developmalignant melanoma. Melanomas inwomen are most common on thelegs and in men they are more com-mon on the back.
When melanoma is caught early itcan be treated successfully. Howev-er, if a malignant melanoma is left itcan spread to other parts of thebody and may prove fatal.
Non-malignant melanoma Over nine in 10 skin cancers arenon-malignant and these are a moreeasily treatable and less likely tospread. These cancers are mostcommon on areas of skin frequentlyexposed to the sun such as thehead, neck, hands and forearms.Those most at risk have, for exam-ple, fair skin, red or fair hair, manymoles or freckles, a personal or fami-ly history of skin cancer, and experi-ence of sunburn. Over 65,000 newcases are reported annually inthe UK.
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O N C O L O G Y
Increasing the range ofminimally invasive tumourtherapy Imaging, targeted drugs, magnets and more…Surgery is no longer the automaticchoice to eradicate malignanttumours. For about a dozen yearssmall tumours and metastases inthe liver have been eliminated byheat generated at the tip of acatheter, a technique that beganwith liver tumours, has spread tothe lung, and could be applied tobreast and prostate cancers inthe future.
Whether using laser beams, high-frequency electrical current or,more recently, highly-focusedultrasound – direct imagemonitoring is used to controlsuch procedures.
MEDICA 2006 is presenting arange of innovations in this area.
Magnetic resonance tomography(MRT) is considered one of theideal tools for these less invasiveprocedures, not only because it isradiation-free, but also because itprovides a continuous picture oftemperature distribution.
The prognosis for patients withmalignant liver tumours is poor,
Blood in healthy liver tissue is mainlysupplied from the portal vein, whereastumour tissue is supplied via the hepaticartery. By taking the latter route, theradioactive microspheres can be guideddirectly to diseased tissue
Unlike conventional radiation therapy, selective,internal radiotherapy (SIRT), developed inAustralia, uses tiny radio-active microspheres toattack malignant liver tumours. This techniqueradiates the cancer cells not externally, therebypassing through healthy tissue, but directlyinside the liver tumour. Munich UniversityHospital was the first to introduce thistechnique to Europe. There, radiologists andoncologists have now treated about 70 patientswith SIRT.
Reporting on this development for EuropeanHospital, Guido Gebhart explained: ‘SIRT is aminimally invasive therapy, during whichradioactive microspheres, made from syntheticresin, are introduced directly into diseasedtissue via a catheter passed through thehepatic artery. The microspheres remain withinthe liver and, during their precisely targetedradiation, the tumour shrinks or is destroyed.‘SIRT is reported as being well tolerated by
patients. In addition, the healthy surrounding liver tissue tends to recoverquite quickly.
The new therapy is particularly suitable for cases where other treatmentoptions, such as surgery or chemotherapy, cannot be considered or havefailed. ‘SIRT now offers hope for those people for whom previously allother treatment options wereexhausted. SIRT has a positive effecton the course of the disease for mostpatients,’ said Professor MaximilianReiser (above), Director of the Institutefor Clinical Radiology.
Over 3,000 patients worldwide havebeen treated with SIRT, and variousstudies have confirmed itseffectiveness. An Australian studydocumented a significant shrinking oftumours in 73% of patients.
SIRT is now being carried out atseveral German hospitals. The medicalinsurers cover certain individual cases.At Munich University Hospital, theinsurers have agreed 30 courses oftreatment.
particularly for those with largetumours; following diagnosis, theiraverage survival period is less thansix months and, even for those withsmaller tumours, estimates arethat only one in four will survivebeyond three years. Laser thermo-ablation, which involves destroyingsmall tumours by applying localisedheat, promises better survivalrates.
Using this technique, at Frankfurtam Main University Hospital,Professor Thomas Vogl carried outtests on 80 patients. The resultsare impressive: 60% (comparedwith the usual 25%) reached athree-year survival period; around33% survived for five years.
With twelve years’ experience inthis area, Prof. Vogl now intends touse this therapy for tumours andmetastases in the lung - an area ofmany complications. The frequencyof this disease makes the lessinvasive procedure particularlydesirable. Bi-polar high-frequencyablation could be combined with
localised chemotherapy drugs toachieve success. To confinecytostatic substances within atumour, magnetic particles havebeen added to them, so that whentwo magnets are applied externally,the iron particles – and thus themedication – cannot migrate.
Aiming to localise prostatecancer treatment, researchers atthe Institute for Diagnostic andInterventional Radiology, inFrankfurt’s Johann WolfgangGoethe University Hospital, aredeveloping ‘galvanotherapy’. In thismethod, iontophoresis (orelectromotive drug administration[EMDA]) is used. A DC currentapplied to the prostate gland drawsthe drugs to the cancer site.
The disadvantage in thesetherapies is that any tumour that isnot totally destroyed will growagain - and more quickly than isusual, resulting in frequentaftercare.
Source: Medica
Microspheres destroyliver tumours
Professor Reiser: ‘SIRTis an innovative cancertherapy. The source of
radiation is guideddirectly into the tumourand does not, as is thecase in conventional
radiation therapy,radiate through healthytissue from the outside’
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DRUG TRIALS Inverness Medical Innovations develops and manufac-tures rapid diagnostic products for use in preventive aswell as interventional therapies. Information frompatients’ body fluids, or tissue, assists physicians todiagnose disease, as well as to measure a patient’sresponse to a specific therapy. Its range of clinical diag-nostic products already includes, the well-known brandsClearview, Inverness Medical TestPack, Binax, Deter-mine, BioStar, and many others. ‘Our high qualityimmunoassays in pregnancy testing and fertility, respi-ratory, enteric and infectious diseases, autoimmune dis-orders, osteoporosis, cancer and cardiology, havedemonstrated proven efficiency in clinics, hospitals andlaboratories internationally,’ the firm points out.
Currently, Inverness Medical Innovations reports thatit is exploring opportunities to optimise the use of itstechnologies, as well as continually evaluating othertechnological advances, for development or acquisition,in a variety of medical/health areas.
For the last few decades, pharmaceuti-cal companies have increasingly chosento use medium-size contract researchorganisations (CROs), or smaller organ-isations, rather than the larger organisa-tions, due to their enhanced responsive-ness and flexibility, that provides goodgeographic coverage, a broad therapeu-tic portfolio and years of experience inmanaging complex trials. Their abilityto advise companies on realistic timelines for the clinical development ofdrugs in a range of therapeutic areas,and on changes in regulatory guide-lines, has placed them in an ideal posi-tion to handle major projects, while stilloffering clients a more personalisedservice than the largest CROs, accord-ing to the market consultancy firmFrost & Sullivan.
F&S reports that the European mar-ket for CROs earned revenues ofUS$4.80 billion in 2005, and estimatesthis figure will reach US$10.21 billionin 2012.
Facing increasing competition in arepeat business environment, CROsmust cope with the pressures to winclient businesses and deliver onexpectations, F&S advises. ‘Smallerfirms or institutes with limited offer-ings often have greater difficulty com-peting against larger full-service CROcompanies with a wide breadth ofservices, since many sponsors preferworking with a one-stop shop thatcan take a product through its entiredevelopment life cycle through tostages of drug approval.’
Small and medium-sizecontract research
organisations (CROs)have huge potential
Ever expanding rapiddiagnostic products
Against a backdrop of stricter re-gulations, guidelines, price and reim-bursement legislation resulting in achanging business environment, re-search within the pharmaceuticalsindustry has tripled in the last 25 years,with the pipelines of the top compa-nies doubling.
‘The growing market in drug devel-opment, and increase in R&D in-vestment – including that of small(biotechnology) companies – coupledwith an increase in development costs,the importance of timely developmentof new products and the need toreduce time-to-market, have emergedas important financial considerationsfor achieving business growth,’ said Dr Amarpreet Dhiman, ProgrammeLeader of Drug Discovery at F&S.‘Even as current pharmaceutical andbiotechnology R&D spending levelssurpass US$36 billion, and blockbusterdrug development plateaus off, CROsare expanding in the direction ofbecoming either niche-specific or largeservice providers.’
Growth in the clinical trial industryis inextricably linked to growth in thehealthcare industry. In particular, esca-lating R&D activities have led to ahigher demand for clinical trial ser-vices that meet global standards. How-ever, even while it expands, the CRO industry faces a raft of new chal-lenges, F&S adds. ‘Principal challengesinclude those related to quality, effi-ciency, therapeutic expertise, EU regu-lations, and better sponsor-CRO com-munication,’ Dr Dhiman pointed out.‘Despite these considerations, compa-nies in the CRO industry are experi-encing transformed revenue growthrates, together with limitless potentialfor expansion.’
Soaring drug discovery developmenttimes, lengthy regulation-mandatedtesting and reviewing processes (withapprovals often taking up to 15 years),as well as rapidly escalating R&Dexpenditures are causing clients toplace increasing pressure on CROs toyield quick results.
In addition, because a drug’s patentprotection begins at the R&D stage,manufacturers are trying to movethrough R&D time lines at a quickerrate, to save as much patent-protectedtime as possible and profit fromdrug sales.
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C A R D I O L O G Y
Dual source CT reducesheart catheterisations
When introduced about a year ago, the first dual source CT was forecast to becomeparticularly relevant in cardiology. Today, its clinical application can be evaluated.Daniela Zimmermann asked Professor Stephan Achenbach (SA), of the CardiologyDepartment, Erlangen University Hospital, about its impact on cardiac diagnostics
Stephan Achenback is alsoPresident of the Society ofCardiovascular Computed
Tomography(SCCT)
Prof. Achenbach: Computedtomography, in general, hasgained importance in cardiology.Beginning with the 16-row CTscanner, under certain circum-stances it had become possible tovisualise coronary vessels. The 64-row scanner provides even morereliable results. That was a majordevelopment, because before theintroduction of CT to cardiology,to examine coronary vessels usu-ally invasive catheterisation had tobe used. Today, we can decide farbetter which patients require acatheter and which do not. Insome instances, CT can serve asthat filter, which helps to reducethe number of catheterisations.
It is above all cardiology thatprofits from dual source CT: dueto shorter exposure times motionartefacts are avoided, whichmeans the heartbeat no longercauses imprecisions. This has twoadvantages: first, a more preciseimage of the coronary vessels, andthus improved diagnostic reliabili-ty. Second, to avoid movementartefacts the patient’s heart rateno longer has to be slowed with abeta blocker. Also, we can nowexamine patients with high heartrates. Could the new 256-row
scanners do this?
While the number of rows of a CTis relevant for the total duration ofthe imaging process, it does notnecessarily improve the temporalresolution, and thus image quality.With the 256-row scanner the totaltime required for image generationwill be further reduced, whichmeans the patient’s breath holdtime will be shorter. However, theexposure time per image will notchange. Consequently, a 256-rowscanner does not automatically
provide improved temporal resolu-tion and image quality comparedwith a scanner with fewer slices.The important issue with the dualsource CT is that it has two X-raysources that are positioned at a 90°angle to each other. A convention-al CT image usually consists of180° data, which corresponds toabout half a rotation. With dualsource CT, we only need a quarterof a rotation, due to the twosources. An image can be takentwice as quickly than before andexposure time is shorter. Thismeans more images are entirelymotion-free. An increased numberof rows alone does not offerthis effect. Which patients benefit from
dual source CT?
Typically, those presenting symp-toms that do not unambiguouslyindicate the presence of a coro-nary artery narrowing or occlu-sion. For example, this is quitecommon: There is a clinical reasonto check for stenoses, but thesymptoms, and the stress examina-tions, indicate only low or average
probability of coronary heart dis-ease. Before, in order to excludecoronary stenoses, these patientshad to undergo catheterisation.Today, we can perform a cardiacCT first. If the CT shows normalcoronaries, we can be very certainthat no stenoses are present andthe patient doesn’t need catheteri-sation. Another example: A patientwith acute chest pain presents atemergency admissions, the ECG isnormal; there are no other signs ofmyocardial injury or impairment.With a CT we can determinewhether the heart causes the pain,or if there’s another reason. Helpedby CT we can provide a quickanswer – a crucial factor in acutecare.
Additionally, CT enables us todetect coronary plaque and calcifi-cation, early. Thus, patients whodon’t yet show stenoses - but con-siderable atherosclerosis – can betreated early, for example withlipid-lowering therapy and acetyl-salicylic acid - and we recommendthey change their lifestyle. CT alsohelps classify a patient’s risk fac-tors. It can be rather difficult toevaluate the actual risk, for exam-ple, if a patient has average choles-terol levels. Here, CT provides fur-ther information, particularly onthe degree of calcification. CT isvery reliable in that respect. Thus,CT allows categorisation ofpatients for further treatment andcan be useful in some selectedasymptomatic individuals.
In everyday cardiological prac-tice, dual source CT is often verybeneficial. However, since theexchange between radiologists andcardiologists helps to make full useof the method’s potential, closecooperation between them isvery useful.
A small, powerful newultrasound catheter,named AcuNav 8F,improves access to theentire heart, SiemensMedical Solutions reports.Sized at eight French, it is33% smaller in the cross
sectional area than the existing AcuNav 10F. Accordingto clinical evaluations, the new catheter’s smaller size,along with the same high resolution and imaging depthof AcuNav 10F, is a significant improvement and allowsaccess even down to small patients.
‘The size and flexibility of the new catheter were veryimpressive and provided us with improved visualisationof defects with less trauma to patients,’ said Ziyad MHijazi, MD MPH, Professor of Paediatrics and Medicine,University of Chicago, USA. ‘During evaluation, Iperformed two atrial septal defect (ASD) closureprocedures and one patent foramen ovale (PFO)procedure. Two of the patients were quite small; thethird weighed just over 118 kilograms. With the 8F, Iwas able to get spectacular images of clinicalsignificance with no problem at all.’
Dr Hijazi agreed with other clinical evaluators aboutASD closure procedures in smaller patients. ‘There willbe no need to use trans-oesophageal echocardiography(TEE) in small patients, and the operator will be ableto perform the echocardiographic evaluation andclosure simultaneously, therefore the resources in thedepartment will be used more efficiently.’
The new catheter provides visualisation of vascularand cardiac anatomy and physiology, measurement ofblood flow and visualisation of other devicesthroughout the entire heart. Klaus Hambüchen, Headof the Ultrasound Division at Siemens MedicalSolutions, said the trend is towards more catheter-based procedures, which demands new visualisationtechniques. ‘The ability of intracardiacechocardiography to see anatomy and devices underblood will enable many new applications such as mitraland aortic valve repair using catheters, and willaccelerate the adoption of catheter-based proceduresthat reduce trauma and recovery time for patients.’
The AcuNav 8F catheter is currently available on theSequoia ultrasound platforms, the Acuson CV70cardiovascular system and the Acuson Cypresscardiovascular system.
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c o m p a n y n e w s
11
R A D I O L O G Y
NEONATAL MRI OF PREMATURE BABIES Predicting neurodevelopmental risk
By Cynthia E Keen
Infants born very prematurelyhave a high probability ofexperiencing behavioural andneuro-cognitive impairmentsduring childhood and adolescence.Globally, about 2% of all infantsare born before 32 weeks ofgestation. Due to medicaladvances in the last 20 years,around 85% of those infantssurvive in countries with hospitalsequipped with neonatal intensivecare units.
This impressive statistic isbittersweet, because the quality oflife of very premature babies mightbe severely compromised. Almost50% of these children will havesignificant cognitive, behaviouraland social disabilities, and 10–15%will develop cerebral palsy andneurosensory impairment. Thecost of years of medical treatmentand special education is onerousfor families, healthcareinstitutions, and the governmentsthat pay for their citizens’healthcare.
abnormalities, and 49% had grey-matter abnormalities. 48 monthslater, after a comprehensiveneurodevelopmental assessmentof each child, the researchersfound significant associationsbetween the severity of identifiedabnormalities and the child’ssubsequent risk of adverseneurological outcomes.
Research team member Terrie E
changes that can be measured tomonitor the impact ofinterventional treatment on thebrain during the first 12–24weeks of life in a neonatal wardwill lead to discoveries of moreeffective treatments. Sheobserved that similar results arebeing identified by the NeonatalMRI group at HammersmithHospital.
Utilization of medicaltechnology that will improve an
individual’s life is a priceless gift.Yet MRI imaging is expensive. Willthe cost of routinely performingMRI scans of very prematureinfants, to identify those atgreatest risk, lead to treatmentsthat will reduce the overallmedical and additionaleducational/societal cost of caringfor these babies during theirchildhood and adolescence? Thequestion is significant, and theanswers are still to be determined.
Inder MD, Associate Professor ofPaediatrics, Neurology andRadiology at WashingtonUniversity School of Medicine(St. Louis, Missouri, USA) saidthe study results were importantbecause MRI scans can predictthe outcome of very prematureinfants better than any otherclinical predictor, imagingpredictor or combination thereof.She and her colleagues believethat the ability of MRI to detect
A global initiative by neonatalpaediatric and imaging specialistshas been underway since the mid-1990’s to utilize MRI imaging toidentify brain abnormalities andinjuries, so that treatments can beidentified to minimize futuredisabilities. MRI is non-invasiveand emits no radiation.
The Neonatal MRI ImagingGroup at Imperial College Londonand Hammersmith Hospital, whichhave pioneered this initiativeestablished the world’s firstdedicated neonatal MR scannerfor the neonatal ward in 1996, andgarnered a second world’s ‘first’with the only dedicated neonatal3.0-T system, installed in 2005.The role of the NeonatalNeuroscience Research Group,headed by David Edwards MD,Professor in the Division ofClinical Sciences, Imperial CollegeLondon, has been to understandthe causes and consequences ofneurodevelopmental impairment,so that strategies can be devisedand initiated in the perinatalperiod of life. Numerous studiesare in progress that utilize MRIimaging.
In Australia and New Zealand,at the Royal Women’s Hospital(Melbourne) and the ChristchurchWomen’s Hospital (Christchurch),a study conducted between 1998and 2002 of 167 infants born at 30weeks of gestation or less,strongly indicates that MRI brainscans become a mandatorystandard of care for verypremature infants. In the study,published in The New England
Journal of Medicine (17/8/06),MRI brain scans performed atterm equivalent could clearlydisplay white-matter and grey-matter abnormalities.
To categorize infants accordingto the extent of their cerebralabnormalities, these were scoredindependently.
Of the 167 infants, 4% hadsevere, 17% had moderate, and51% had mild white-matter
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Proton
12
n e w sR A D I O L O G Y
ULTRASOUNDGUIDELINES INCREASE THE USE OF CONTRAST AGENTS
The positive effects of protonrays have been known foryears. However, Germanystill lacks institutions thatutilise those effects. With
the construction of RPTC: Rineck-er Proton Therapy Centres (RPTC)in Munich and Cologne, Hans
Rinecker MD, hopes to promote
Although published less than two
years ago, the Guidelines for the
Use of Contrast Agents in Liver
Ultrasound, developed by the
European Federation of Societies
for Ultrasound in Medicine and
Biology (EFSUMB), early data
indicates that they have played a
strong role in increasing the use of
contrast enhanced ultrasound
(CEUS) for evaluating focal liver
lesions by up to 30%.
‘Many medical centres were
waiting for these Guidelines,’ said
Dr Riccardo Lencioni, Professor of
Radiology at the Department of
Eliminating Windows-based imageprotocols, SONOACE in Germany,has produced the SonoAce X8which, the firm reports, isthe first Smart S/Wprotocol-basedultrasound imageprocessing system.‘SonoAce X8 embracesthe optimum configuration ofhard- and software by using SmartS/W protocol. The equipment notonly adapts all the premiumfunctions of existing equipment,e.g. Live 3D, 3DXI, and FullCardiology Package, but also
Oncology, Transplants and
Advanced Technologies in Medi-
cine, University of Pisa, Italy. ‘In
the absence of specific, clear rec-
ommendations for use, contrast
enhanced ultrasound had some
difficulties being accepted within
the hospital community.’
The Guidelines were created in
recognition of the growing clinical
realizes optimum imageperformance with Dynamic MR,Full Spectrum Imaging, and SCI(Spatial Compound Imaging).’
The system also can beupgraded in simple steps througha new in-built protocol and thecompany adds that the upgradedspeed of operation contributes tooptimised patient throughput.
Compared with existingultrasound machines, moreaccurate and compact datameasurements, along with abetter reporting function,are promised.
applications of CEUS, which has
emerged as an imaging modality in
its own right. The goal of the
Guidelines is to help standardise
the use of ultrasound contrast
agents and improve patient man-
agement.
The Guidelines cover ultrasound
contrast agents currently
approved for use in Europe,
including Bracco’s SonoVue, a sec-
ond-generation ultrasound imaging
agent. SonoVue has been approved
for all EU countries; an application
for FDA approval has been submit-
ted.
Based on comprehensive litera-
ture surveys, encompassing results
from prospective clinical trials, the
first version of the Guidelines
focuses on evaluation of known or
suspected focal liver lesions. They
cover numerous aspects of CEUS
for focal liver lesions, including:
● General considerations: imaging
techniques with CEUS, investiga-
tor training, and safety issues.
● Characterisation: investigational
procedures, image interpretation
and evaluation, recommended use
and indications.
● Detection: investigational proce-
dures, image interpretation, rec-
ommended use and indications.
● Monitoring of local ablative
treatment: investigational proce-
dures, image interpretation (defin-
ition of complete treatment
response), recommended use and
indications.
Liver imaging is one of the most
important applications for CEUS
with SonoVue. It can be used to
help diagnose primary and
metastatic tumours in the liver
and other types of liver disease.
CEUS also can accurately evaluate
treatment for liver cancer such as
RF thermal ablation (a technique
that uses heat created by radio fre-
quencies to destroy liver
tumours). When the treatment is
performed under general anaesthe-
sia, the ability to identify the pres-
ence of residual cancer areas can
lead to immediate re-treatment,
potentially reducing the need for a
second anaesthesia and shortening
hospitalisation time.
According to Professor Lencioni,
about 170–180,000 abdominal
CEUS examinations were per-
this therapy nationwide – but as yetno firm date is set for their opening.Guido Gebhardt asked what causesthe delay and what is the future pro-ton therapy. Dr Rinecker: The delay has beencaused by a part that requires a typeof network process where differentsystems are interfaced. This affectsthe production and trial of thecyclotron that accelerates protonswith a magnetic field. Instead ofcompletion in mid-2004, the centrewas finished in May 2006. After-wards, there was an official accep-tance test for the first of five treat-ment areas; four are exactly thesame, one is specialised for eyes andcranium. The test, which included asimulated radiation treatment, wassuccessful – on the whole. The onlyproblem we need to solve is that thesystem did not process a simulatedincident correctly. After a power cut,due to the interruption, the systemwas unable to remember where tostart treatment.
formed in Europe in 2003 and 2004;
virtually all of these were liver
scans. After publication of the
Guidelines, in 2005 the number of
these scans soared to 240,000.
Prof. Lencioni helped draft the
Guidelines and has been monitoring
their impact on clinical practice
throughout Europe.
‘The development of the Guide-
lines underscores that CEUS has
moved beyond the research stage,’
Professor Lencioni said. ‘They pro-
vided a very important official doc-
ument that helped shift CEUS from
an investigational procedure to an
accepted part of clinical practice.’
In June 2005, the European Asso-
ciation for the Study of the Liver
hosted a consensus conference in
Barcelona, Spain, in partnership
with its American and Japanese
equivalent societies, to update the
current guidelines for the clinical
management of liver cancer, which
date back to 2000. Aiming to have
CEUS incorporated in the clinical
management of liver cancer
throughout Europe, US, and Japan,
the role of CEUS in early diagnosis
of liver tumours was discussed.
‘From country to country, there are
some differences in the practical
use of ultrasound contrast agents,’
said Prof. Lencioni. ‘In the United
Kingdom, for example, many scans
are performed by radiographers,
while in other countries only med-
ical doctors perform ultrasound.
Reimbursement is also a national
issue.’
Despite some national variations
in the approach to the Guidelines,
radiologists’ support for them
reaches across national boundaries
to include all of Europe. The
groundswell of appreciation for the
current Guidelines indicates future
expansion should be well received.
EFSUMB met in September this
year to evaluate the effect of the
Guidelines and to discuss the possi-
bility of expanding them to cover
applications not included in the ini-
tial publication.
Extending the Guidelines to
include other applications will
depend on the pace at which clini-
cal trials conclude, publication of
results, and unified recommenda-
tions. Any future applications will
require consensus recommenda-
tions, technique indications, and
clinical flow charts - all of which
are included in the current liver
CEUS Guidelines.
ULTRASOUNDThe SonoAce X8
EQUIPMENT UROLOGY
LAPAROSCOPY ARTHROSCOPY
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OUR TECHNOLOGY
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Hall 10 - Booth B57
therapy: under construction
RPTC in cooperation with a sig-nificantly more experienced Bel-gian company. We have not givenup hope.When is the Centre likely to
open?
Only the software bug stopped usgetting our licence, so everythingdepends on just this one smallissue. As soon as we reach anagreement, we will be under amonth away from opening theclinic.Are you planning further
proton therapy centres – in
Essen, Kiel and Berlin?
I was recently invited to meetwith the Germany Society forRadio-oncology – comprised ofradiotherapists who initially were
13
R A D I O L O G Y
MRI software fordetection & diagnosis
This technical shortcoming canbe traced back initially to a keymanufacturer in the proton systemand, since May, this manufacturerhas been pushing up the projectcosts that we had agreed on tounforeseen levels. It is basically try-ing to obtain a multiple of theamount that the Technical Inspec-
and Hanover Leasing and the NRWBank (the state bank of NorthRhine-Westphalia), as well asmyself. Of course, it isn’t alwayseasy to keep everyone happy, butthe project is well funded and, lucki-ly, my financial background is verystable. At the moment everything isfinancially safe, but we are losing
around one million euros amonth.What will happen in Cologne?
One possibility would be for athird company to finish the cen-tre. However, the company wehave chosen – apart from the soft-ware problem mentioned earlier –has the most advanced concept
by international stan-dards. Changing toanother companywould entail a loss ofknow-how. The prob-lem might also beresolved if DrClement’s intermedi-ation bears fruit. Thethird option wouldbe for us to buy partsfrom one of our pre-sent suppliers. Wehope to solve thisamicably. We arehappy to lead a ‘mar-
riage of convenience’. For themoment we have put the Cologneproject on hold. Our ideal solu-tion would be to integrate thegood components from our pre-sent supplier into the Cologne
NEW
Left: Completed almost two yearsago, the RPTC Centre in Munich isstill not open
Above: The System: A small softwareerror held up the project's officialoperating licence
very negative, because theywork with linear accelerators. Alaw introduced in 2001 statesthat, in all cases, we mustchoose the therapy that uses thelowest radiation dose – whichmeans proton therapy has anadvantage factor of three to five.This means a patient’s healthytissue only receives a third to afifth of radiation they’d receivefrom linear accelerators. Scien-tifically, we are no longer fight-ing over proton therapy – every-one agrees it’s only a matter ofwhen it will come. The new cen-tres can only help to promoteproton therapy in Germany. Tocover the entire nation we’dneed 20 centres the size of theRPTC in Munich. The advan-tages regarding radiation doseare physical, they are not depen-dent on the types of tumours wetreat. There are no scientificreasons why the advantages ofproton therapy should be limit-ed to certain types of tumours.Proton therapy will, in time,completely replace radiationwith photons.
Hans Rinecker
syngo Blade, is the latest total imaging matrix (TIM) technology-powered mag-netic resonance imaging (MRI) software from Siemens Medical Solutions. Thecompany reports that the system is ‘…ideal for paediatric and difficult-to-man-age patients in neurological and orthopaedic imaging, syngo Blade is not affect-ed by flow and motion. By continuously acquiring low-resolution images, thisapplication measures and corrects any motion, providing clear images. With itslow sensitivity to movement, medical professionals can focus on reducing seda-tion rates in paediatric and anxious patients, increasing time efficiency.’
This application is available on all Tim systems, including, in the Magnetomrange, the Avanto, Symphony, Espree and the Trio.
Using a single 17 inch LCDmonitor, the system monitors both apatient’s scan and data analysis inreal time.
The system generates high picturequality, 1280 x 1024, by using andtracing the best image size for themonitor – the first trial of such atechnique in this field, Medisonreports.
SonoAce X8 will becomecommercially available in the first sixmonths of 2007. It is now on showat MEDICA (SONOACE booth: Hall 9,B 60) – and later will be at the RSNAin Chicago (later in November).
tion Authority – South, which thebanks commissioned to monitorthe project, has deemed adequate.The costs – about 40.5 millioneuros, initially envisaged for thispart of the project – have nowincreased to around 70 millioneuros. We can only guess as to thecompany’s motive for this. Sincethen we have been trying to negoti-ate, but to no avail. Because one ofthe banks as well as the companyin question are based in NorthRhine-Westphalia former StatePremier Clement is closely follow-ing our negotiations.Surely it is not easy to provide
interim funding in the region
of 120 million euros over such
a long period?
Adding everything up, the sum iscloser to 150 million euros, includ-ing a patient hotel, which is part ofthe care concept. In all, fiveinvestors are involved in the pro-ject, two banks, the West LB AGand HypoVereinsbank Unicredit,
14
I N N O V A T I O N S
It’s a new colour – but not a quality change – for new products BOWA-electronic GmbH reports. Describing its choice of orange to re-brand itsimage, the company said it is: ‘…a dynamic new look, as fresh as thewind. You’ll see this in our products, for example, in a brand new modelsoon to be launched in our trusted ARC-series; or at our new buildingproject in Gomaringen, Germany, where our entire operation is efficientlypooled at a single site, from planning and development to production andmanagement.’
BOWA products will be on show at MEDICA (Dusseldorf, 15–18November) in Hall 10, booth G05.Details and company newsletter: www.bowa.de.
BOWA becomes BOWA
Electro-medical safety testermeets new IEC 62353 standardRigel Medical, part of the Seaward Group, has launched a new biomedicalelectrical safety analyser – the Rigel 288 – which meets the IEC 60601, andthe forthcoming IEC 62353 in service test standard for electromedicalequipment. ‘The ergonomically designed, hand-held safety tester combinesinnovative lightweight design and advanced test technology with a range ofspecial features including battery power, blue tooth connection for datatransfer and a menu driven easy to operate user interface.’
The analyser provides automatic, semi-automatic or fully manual electricalsafety testing of all electromedical equipment. Importantly, preset orcustomised test programmes can also be selected to enable users to complywith individual, local or international standardsoutside the scope of IEC 62353 and IEC60601 to provide fast and efficient testingof medical equipment with up to 10individual patient connections or appliedparts, Rigel adds. ‘The instrument’s internalmemory can be used to store details oftest results for transfer to a PC database,alongside user defined inspections andchecks on such equipment as SpO2, NIBP,ECG and other electromedical equipment.’
This, with the Rigel 277 and Rigel 266and Rigel 300 series (which includes a rangeof testers to verify the functionality of NIBPtesters, pulse oximetry analysers, ventilatorsand defibrillators) and the company’s other testequipment, are on show at MEDICA.
Hall 11. Stand G48
NEW
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EUROPEAN HOSPITAL
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Correspondents
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Britain: Brenda Marsh, Ian Mason. Italy: Danilo Camisas-
ca. The Netherlands, Belgium: Michiel Bloemendaal.
Poland: Pjotr Szoblik. Spain: Eduardo de la Sota. USA:
Karen M Dente, Cynthia E Keen, Ivan Oransky, Craig
Webb.
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Höherweg 287, 40231 Dusseldorf, Germany
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