The Xcelerant Hydro Delivery System features a hydrophilic coating which attracts and holds water at the device surface to reduce friction. The coating is designed to aid navigation through the femoral and iliac arteries en route to the aorta.

“The combination of the Xcelerant Hydro Delivery System and the Talent Abdominal Stent Graft represents another major step forward for the treatment of patients with abdominal aortic aneurysms,” said Dr. Manish Mehta of Albany Medical College and Albany Medical Center Hospital in New York. “The hydrophilic coating takes deliverability to a new level and gives endovascular interventionalists like me greater control over the deployment of this excellent stent graft, which has no equal in terms of sizes and profile. Taken together, these technologies simplify the procedure and enhance patient care – a powerful combination indeed.”

“The Xcelerant Hydro Delivery System again demonstrates Medtronic’s innovation in the field of EVAR,” said Tony Semedo, vice president and general manager of Endovascular Innovations at Medtronic. “The launch of the Talent stent grafts earlier this year made EVAR available to significantly more patients than possible with earlier technologies. Now, by introducing the Talent Abdominal Stent Graft on the Xcelerant Hydro Delivery System in the United States, we have enhanced navigation. All of these innovations benefit physicians and patients alike.”

Medtronic Launches New Medical Device in U.S. to Improve Treatment of Aortic Aneurysms...

Flashbacks: Talent Stent Graft with the New Delivery System Goes on Sale in US; Talent Thoracic Stent Graft System Approved in US ; FDA OK's Endovascular Talent Stent for AAAs; Talent Thoracic Stent Graft System; Talent Thoracic Stent Graft System

From the announcement:

The method uses electromagnetic tracking and facilitates interventions such as precise and quick needle placements – for liver biopsies, for vertebroplasties when stabilizing fractured vertebras, or for cancer pain treatment.

For a number of years Siemens has been working together with physicians on navigation solutions that support interventional radiologists during minimally invasive needle procedures as well as improve patient treatment. The innovation iGuide CAPPA is part of the comprehensive navigation solution from Siemens. For a number of months now, the system is being successfully used by several hospitals. "iGuide CAPPA allows for precise and safe placement of electrodes or biopsy devices even in regions that are difficult to evaluate with conventional fluoroscopy,“ explains Dr. Martin Skalej, Director of the Institute for Neuroradiology at the University Hospital in Magdeburg, Germany. He uses the system primarily for different interventions of the spine, e.g., for spinal radiofrequency ablations and for discographies or kyphoplasties. "No further imaging is necessary during the intervention. This reduces the x-ray exposure compared to previous interventions performed in the CT“.

The principle is a simple one: prior to inserting the needle, the Artis zee C-arm generates a 3D soft tissue image of the anatomy to be treated, which is used for orientation by the physician. A sensor in the tip of the needle is tracked in an electromagnetic field created via a field generator. These data are transferred in real time to the iGuide CAPPA system which shows the position of the needle tip on a monitor and superimposes on the previously generated three-dimensional data set of the anatomy. This provides the physician with both the necessary anatomical information as well as the exact position of the needle, so he can safely perform the needle procedures. This method is especially suitable for lengthy and complex interventions by providing improved spatial orientation and hence faster and safer navigation to the actual target. Additionally, the required radiation dose is greatly reduced.

Product page: iGuide CAPPA...

Press release (.pdf)...

THz radiation offers several advantages over x-rays. As the energy of light is very low, THz radiation is less damaging to materials. Similarly, THz radiation is strongly absorbed by water, which means that soft tissue of the human body can be imaged by THz rays. For these reasons, THz imaging and detection is in strong demand in fields as broad-ranging as biosensing and food inspection.

So far, the lack of compact and efficient detectors has hampered the widespread use of THz imaging schemes. The high-resolution on-chip THz detection scheme the researchers report in the journal Nature Photonics1 is based on a technique that uses a small aperture and a probe (as a type of antenna) for THz radiation (Fig. 1). Like planar water waves that move through a narrow slit and are converted into circular waves, THz radiation propagating through the aperture forms dense ‘evanescent waves’.

As evanescent waves decay rapidly in intensity with increasing distance from the aperture, prior designs, where the detector was away from the aperture and/or the probe, had poor detection sensitivities. “In our approach, the detector is integrated with the aperture and the probe, which enables us to directly detect the evanescent wave itself,” says Kawano commenting on the advantages of the design.

The aperture resides within a thin gold film through which the THz radiation passes. The evanescent waves are then enhanced within the narrow gap of a bow-tie shaped gold probe layer before reaching the detector. The detector itself consists of thin semiconductor films with a highly mobile layer of electrons that efficiently absorb THz radiation.

The overall integration of all components on a single chip ensures a simple and robust detection scheme. Indeed, in the first test runs, the researcher achieved high detection efficiencies with a resolution of 9 µm—significantly smaller than the THz wavelength of 215 µm, which is far beyond the possibilities of conventional optics.

RIKEN press release: An all-in-one chip ...

Image: (a) Photograph of the on-chip detector consisting of an aperture, a probe layer and detector. (b) Schematic of the electric field propagation through the device. The evanescent field from the aperture is enhanced by the probe layer and guided towards the thin film detector.

Using the popular Sprinter™ balloon catheter technology, the Endeavor Sprint system puts the highly deliverable Endeavor DES on an enhanced delivery platform, making Medtronic’s flagship DES even easier for physicians to deliver to the site of coronary blockages. The Endeavor Sprint system incorporates a new tip design for a low profile, a new balloon material and an enhanced shaft design which together greatly improve the device’s deliverability.

The robust ENDEAVOR clinical program has demonstrated that the Endeavor stent is associated with exceptionally low rates of stent thrombosis, myocardial infarction and cardiac death, as well as low and comparable rates of clinically-driven target lesion revascularization, out to as long as five years of patient follow-up. Representing various world geographies and patient subsets, the program has enrolled more than 10,000 subjects to date and will ultimately enroll more than 20,000 subjects in a combination of randomized controlled and single-arm clinical trials.

Press release: Medtronic Launches Endeavor® Sprint Drug-Eluting Stent System on Rapid Exchange in United States ...

Product page: Endeavor® Sprint...

The Carotid WALLSTENT is a self-expanding stent mounted on a rapid exchange delivery system, designed to re-open the carotid artery by treating stenoses, and improve blood flow to the brain. The stent features a closed-cell design, engineered for excellent lesion coverage and angiographic results. The system is designed to be highly deliverable and provide access to the toughest lesions.

It is used in conjunction with the FilterWire EZ™ Embolic Protection System, which is designed to capture plaque debris released during the stenting procedure, preventing it from traveling to the brain, where it could create an increased risk for stroke. The device features simplified filter sizing - accommodating vessel diameters between 3.5 mm and 5.5 mm - and offers efficient preparation, deployment and retrieval.

"The closed-cell design of the Carotid WALLSTENT Endoprosthesis is intended to provide increased scaffolding for optimal lesion coverage and a smooth inner lumen," said Barry T. Katzen, M.D., Medical Director, Baptist Cardiac and Vascular Institute, Miami. "This feature will make the Carotid WALLSTENT an attractive new treatment option for U.S. physicians and their patients."

The Carotid WALLSTENT Endoprosthesis with the FilterWire EZ System is the only carotid artery stent system approved in the United States with an indication that includes the treatment of bilateral carotid artery disease (blockages in the carotid arteries on both sides of the neck).

Product page: WALLSTENT® Monorail® Endoprosthesis...

Press release: FDA Approves Boston Scientific's Carotid Artery Stent...

From the press release:

With a generous .025 inch inner diameter, MiraFlex High Flow enables optimal coil delivery and can be used in combination with a wide variety of embolisation materials, including the top-selling MicroNester® and Tornado® Microcoils™ from Cook. A kink-resistant braided construction along the entire length of the catheter shaft to the radiopaque band provides improved torque response and traceability for quicker vessel selection, while maintaining optimal catheter visualisation. The braided design also contributes to the flexibility and durability of the catheter, which carries a rated burst pressure of 1000 psi and achieves the higher flow rates clinicians depend upon.

Each MiraFlex High Flow microcatheter has a hydrophilic coating designed to greatly reduce surface friction, and is engineered with five durometer zones ranging from a stout proximal portion that delivers improved pushability and control, to a soft, flexible distal tip that reduces the risk of vessel trauma.

Press release: Cook Medical Receives CE Mark Approval for MiraFlex™ High Flow Microcatheter

Product brochure: MiraFlex Microcatheter

From The ImaTx Website:

Only 5 percent of falls result in fractures suggesting that there are other non-fall variables that are likely co-determinants of hip fracture such as impact location, bone density and architecture, and proximal femoral geometry that influence the structural capacity of the femur.

Bone mineral density measurements (BMD) successfully identify subjects at risk for fracture and can help physicians select those individuals who will derive greatest benefit from therapy. However, overlap exists in the distribution of BMD of patients with and without osteoporotic fracture, and BMD does not accurately predict the presence of fractures. Thus, factors other than BMD contribute to fracture risk. Key among those factors is alterations and disruptions of trabecular structure.

Substantial overlap exists in the distribution of BMD of patients with and without osteoporotic fracture and that BMD does not accurately predict the presence of osteoporotic fractures and cannot accurately assess absolute fracture risk in an individual patient.

Our preliminary data suggest that measurement of individual fracture risk is feasible using a combination of bone structural, morphometric and biomechanical measurements.

Several methods have been described to examine trabecular structure using conventional projectional radiography. The earliest analysis techniques used microdensitometer-analog computer methods and Fourier transformation techniques. Simple texture analysis tools were then applied indicating that simple geometric patterns can be used to discriminate between the hips of normal controls and patients with osteoporotic fractures. Caligiuri et al. reported that fractal analysis of bone structure using standard 2D radiographs has a significantly greater area under the ROC curve than BMD measurements in differentiating normal patients and patients with osteoporotic compression fracture. Clearly, these preliminary studies provide a strong indication that measurements of bone structure in the hip represent a feasible approach for diagnosing osteoporosis and predicting fracture risk. Our technique for assessment of bone structure in the proximal femur using conventional radiographs is shown

BMD is correlated with in vitro fracture load and can estimate fracture risk in groups of subjects, but is incapable of providing individual fracture risk, specifically adjusted for local bone structure, morphometry, and biomechanical conditions in a given patient.

Combinations of risk factors account for only 20% to 40% of the variability in bone mass and have little value in estimating BMD.

HFPS automated hip radiographic imaging technology measures parameters similar to those used in bone histomorphometry. In general, it involves x-ray digitization, identification of regions of interests, trabecular extraction, background subtraction to obtain an image of trabecular structures, and binarization of those structures.

Check out this white paper (.pdf) from Imaging Therapeutics about the company's technology for structural measurement of proximal femur in pelvic X-rays...

Press release: Imaging Therapeutics, Inc. Receives FDA Approval for Hip Bone Mineral Density

ImaTx website...

The decision support software that has been developed by Philips Research in collaboration with the University Medical Center Hamburg-Eppendorf (Hamburg, Germany), aims to assist in the interpretation of the images to the point where accurate diagnoses can be made by less experienced physicians. This could make diagnostic services for the differential diagnosis of dementia much more widely available.

The Philips/University Medical Center Hamburg-Eppendorf software works by performing three different steps. The first step is to spatially normalize the patient’s brain-scan image by selecting, rotating and scaling the appropriate image slice in order to align it with a standard template. The second step is to compare this normalized image, voxel-by-voxel, with a library of normal (un-diseased) brain scans in order to identify hypometabolic regions in the patient’s brain. After identifying and color highlighting these hypometabolic regions, the final step is to compare their size, shape and distribution against a set of disease-specific patterns for each type of dementia. The software then quantifies, in the form of a percentage value, the degree to which the patient’s scan matches each disease-specific pattern. Ultimately, the diagnosing physician could take the percentages into account when arriving at his or her diagnosis.

In addition to being evaluated for feasibility and usability in a clinical setting by University Medical Center Hamburg-Eppendorf’s nuclear medicine department, with positive results, the accuracy with which the software can quantify a match between the patient’s brain-scan images and disease-specific patterns has been tested in two retrospective studies.

Both of these studies involved using a library of brain scan images, each image having been previously examined by a clinical expert in order to arrive at a differential diagnosis. During the study, each of these images was analyzed by the software and a diagnostic conclusion drawn from its results, based on the disease-specific match percentages generated. These diagnostic conclusions were then compared to the differential diagnoses made previously by the clinical expert. Both studies employed a so-called ‘leave-one-out cross-validation scheme’, in which each patient’s brain scan (the validation data) was compared to the disease-specific patterns in all the other brain scans (the training data). This is a well-known scheme for minimizing bias in tests where the data set size is limited.

In the first study, based on a University Medical Center Hamburg-Eppendorf library of FDG-PET scans from 83 patients, the software achieved better than 98% correspondence with the clinical expert’s interpretation, when programmed to differentiate between brain scans showing no signs of dementia, those showing characteristics of Alzheimer’s disease and those showing characteristics of Frontotemporal Dementia.

In the second, 48-patient study using FDG-PET images provided by the Austin Hospital (Melbourne, Australia), the software achieved better than 80% correspondence when differentiating between scans that had been expert assessed as being un-diseased, suffering from Alzheimer’s, suffering from Frontotemporal Dementia or suffering from Lewy Body Dementia. This second study, involving the differential diagnosis of four disease classes, was a greater test for the software than the first study, because indications of Alzheimer’s and Lewy Body Dementia occur in similar areas of the brain. Nevertheless, the software was able to differentiate between them.

Philips Research technology backgrounder: Philips develops decision support software to assist in the differential diagnosis of dementia

From the Duke press release about the work of Dr. Warren Warren, a Duke chemistry professor, and his colleagues:

The Duke group’s approach involves selective detection of what are called “intermolecular multiple quantum coherences (iMQCs)” in hydrogen atoms. Warren said the use of iMQCs is an application of his lab's 1998 correction of an early “subtle mistake” in the way MRI’s inventors exploited quantum mechanical theory

While MRI theory sees nuclei of hydrogen as miniscule bar magnets spinning in characteristic ways within magnetic fields, it originally ignored certain interactions between those spins, Warren said. “We had to completely rewrite the theory of magnetic resonance to figure out where the mistake was made,” he added.

By incorporating these missing interactions, the Duke chemists refinied both the electronics and interpretation of data from MRI scans to improve heat measurements.

The Duke method exploits three sets of facts: First, water and fat never mix. Secondly, hydrogen atoms in water respond to heat changes but those in fat don’t. Thirdly, water and fat molecules in the body are likely to be positioned within tens of millionths of a meter (or microns) of each other.

Fat and water molecules occurring so close together are subjected to the same magnetic conditions, the Duke chemists reasoned. So the differences between the two types of MRI signals they emit should represent the effect of temperature changes on the hydrogen in water. Calculating the effects of iMQCs -- the subtle interactions between atomic spins -- further improves the accuracy of the comparison.

“So the difference between water and fat is an absolute magnetic resonance thermometer,” Warren said.

The Duke team’s report notes that the technique has been demonstrated in live rodents, including obese animals whose cells mimic those in fatty breast tissue. Because of fat cells’ effects on magnetic fields, breast tissue cannot be temperature-checked using conventional MRI, the report also noted.

Abstract: Accurate Temperature Imaging Based on Intermolecular Coherences in Magnetic Resonance Science 17 October 2008: Vol. 322. no. 5900, pp. 421 - 424

Press release: Duke Innovations Improve Accuracy Of MRI As Internal "Thermometer"...

Image credit: Wellcome images: Transverse MRI scan of a normal head at the level of the orbits....

The radiologists are recruited from across the US in what appears to be a win-win proposition. For physicians, the Telerays system allows for as much or as little work, when and where they want, while simplifying billing arrangements. For hospitals, it adds access to radiologists, including sub-specialists (that may not be available in a smaller center) while potentially allowing for cost savings as well.

From the press announcement by Telerays:

Houston-based Radiologist Daniel Roubein, M.D., founder of Telerays says “Teleradiology was a radical step for the industry, but now serves requests on a routine basis. It provides a safe, easy way to find quality talent at fair prices. And it gives control back to the radiologists to set the fees and accept the cases they want."

His first step was to credential radiologists nationwide and he has had great response…500 inquiries after one week. Telerays’ processes are HIPAA compliant and protect all private health information. Credentialing can take from seven to 30 days and there is no membership fee for doctors or clients. Only radiologists pre-approved by the hospital and imaging centers and fully credentialed with Telerays can bid on the contracts.

To start the bidding process, clients post their requests and all radiologists pre-qualified by them receive an email invitation to bid. The lowest bidder wins the contract, downloads the cases and uploads the final radiology reports. There are no possible delays in diagnosis because the bidding process is settled months in advance “The system has advantages for all parties,” said Dr. Roubein. “Hospitals and imaging centers benefit from market competition that gives them the best price for radiology interpretation services at any given time. By having access to a larger qualified network of radiologists, hospitals and imaging centers can negotiate a better price. There are cost-savings before the bidding even starts as we eliminate the preliminary report,” he added. Telerays provides only final reports.

For radiologists, Telerays reduces the middleman cost and gives a larger portion of the interpretation fee back to the doctor. Most services take up to 50%; Telerays takes 15% and also handles billing.

Telerays' News Release (.pdf) ...

Telerays' website...