International focus on medical innovation

The World’s largest medical trade fair, MEDICA provides a forum to showcase the latest healthcare breakthroughs – including new therapeutic methods for heart diseases and dysrhythmias, the latest advances in endoscopic techniques, pioneering techniques using robotic technologies, and the development of digital innovations with the potential to transform healthcare delivery. The MEDICA halls are dedicated to a number of key sectors of healthcare. These include: electromedical equipment and medical technology; laboratory technology/diagnostics; physiotherapy and orthopaedic technology; medical products (i.e. commodities and consumables); information technology and communications; medical furniture and building technology. Many examples of diagnostic and therapeutic progress will be discussed and presented at the event. High on the agenda, this year, will be improving imaging diagnostics, with the use of ‘image fusion’, and new endoscopic techniques for diagnosing intestinal cancer. Patients and healthcare providers stand to benefit equally from ultrasound-based image fusion. Image fusion results in less radiation exposure for patients and obviates the need for contrast agent, which is toxic to the kidneys (Der Radiologe 2012; 52: 63-69). Healthcare providers can also save money as the number of CT or magnetic resonance tomography (MRT) scans can be reduced. The basic principle of ultrasoundbased image fusion is that computer data or MRT data are ‘incorporated’ in an ultrasound image. This makes spatial orientation, which is difficult with conventional ultrasonography, easier f the examiner. Furthermore, this makes it easier to compare the results of ultrasound scans with each other, which is a significant gain for trend diagnostics. Dr Dirk-André Clevert, assistant professor at the Grosshadern Hospital, said that ultrasound-based image fusion has ‘now become interesting for small hospitals and even for radiologists with their own practice’. “Thanks to this technology, we now have the chance to work with ultrasound without forgoing the benefits of CT or MRT imaging,” explained Dr Clevert. “Most of these patients have, in any case, already had a CT or MRT scan at some stage. We take this data and import it into the ultrasound system and the follow-up scans can be done with ultrasound alone.” Image fusion is not only of great benefit in diagnostics, but also for image-guided invasive surgery. Image fusion is currently proving valuable in diagnosing liver metastases. According to Dr Clevert, up to 50% of tumour patients already have metastases in this organ when the primary tumour is diagnosed. Prostate cancer is another example of an area of application. Such image fusion systems are being offered, for example, by MEDICA exhibitors such as GE, which has already been active in the market since 2008 with the ultrasound device LOGIQ E9, Siemens (Acuson S3000) and also Toshiba (Aplio 500 Smart Fusion).

Diagnosis of intestinal cancer

Another technique which is advancing early detection of intestinal cancer involves the use of endoscopy. There is broad agreement regarding its advantages. The familiar problem is that too few people access the so-called ‘diagnostic gold standard’, that is, the complete colonoscopy by means of white light endoscopy, partially due to misgivings about the uncomfortable examination. Consequently, the search for techniques that find broader acceptance has been going on for several years now. Capsule endoscopy is just one familiar example of such a technique. One option is to restrict the endoscopic examination to a flexible sigmoidoscopy, which is supposed to be less disagreeable. Recently, a major study from the US, based on almost 155,000 patients, showed that sigmoidoscopies can help to reduce the incidence of colorectal cancer and the number of fatalities caused by this tumour (New England Journal of Medicine 2012; 366: 2345-2357). According to the authors of the study, led by Professor Robert Schoen (University of Pittsburgh), the tumour incidence was reduced by 21% within an average time of almost 12 years, in absolute figures from 15.2 to 11.9 malignant tumours per 10,000 personyears. The mortality rate was reduced by 26% (from 3.2 to 2.9 per 10,000 personyears). This outcome was based solely on a reduction of the fatalities caused by distal colorectal cancer (50%). More acceptance (and possibly lower costs) and, of course, a higher rate of detected adenomas are further goals being pursued by the new colonoscopy techniques. One such a technique is water and CO2 colonoscopy, according to Dr Jutta Herzog and assistant professor Dr Axe Eickhoff from the Hanau Hospital. In comparison to conventional, painful ambient air colonoscopy, it significantly reduces the amount of pain and enables the examination of non-sedated or lightly sedated patients without higher costs or significantly longer set-up times (Gastroenterologe 2012; 7: 134-8).