Meta Imaging SolutionsPatient centered innovations

Introduces:

The Chrysalis* breast displacement

management system

For breast radiation dose reduction and image

improvement

* Patent pending

Perspective on radiation dose

• Increased use of CT imaging– Increased utilization in general– 3D imaging applications– Expanded indications including• CTCA• PE protocol Chests• CT Urography

Perspective on radiation dose

• Lifetime attributable risk of cancer from a single CTCA Scan(Einstein, et al, JAMA 298(3):317-323.)– 20 yr. old--0.70%-women, 0.15%-men– 40 yr. old--0.35%-women, 0.099%-men– 60 yr. old--0.22%-women, 0.081%-men

Lifetime attributable risk of Cancer Einstein, et al, JAMA 298(3):317-323.

Chrysalis, perspective for CTCA • Cardiovascular disease is increasing in prevalence – Aging Baby Boomers mean more elderly patients– Increasing rates of obesity– Heart disease is the leading cause of death in women

• CT Coronary Angiography developed to non-invasively image the coronary arteries– Images are excellent and improving– Radiation dose to the breasts in women is significant,

approximating 20-25 mammograms• Limited scan plane to visualize the heart

Chrysalis, perspective for Abdominal CT

• CT Abdomen is a common CT examination– The breasts are in the imaging plane on most

Abdominal CT examinations in women– CT Abdomen is relatively common in young

women because of the high incidence of abdominal pain

– Bismuth shielding is used to decrease breast radiation dose, about 35-40% but the breasts remain in the imaging field and produce imaging artifact

• Chrysalis advantages– Breast displacement upwards• Away from the abdomen for complete displacement out

of the imaging plane• Out of the imaging plane for CT Coronary Angiography,

particularly the peri-areolar and upper outer quadrants, with effectiveness of displacement dependent on the breast size and density • Potentially useful for CT for Pulmonary Embolism in

young women

• Chrysalis advantages– Comfortable– External lead shielding can be added to further

improve dose reduction out of the imaging plane– Adaptable to a wide range of patient sizes– Dose reductions apply to all imaging techniques

such as prospective gating and 256-slice CT

Breast dose reduction strategies for CT imaging

• CT Coronary angiography– Prospective gating– Partial volume scanning– Bismuth shielding– Automatic attenuation correction– Breast displacement/external shielding-Chrysalis

• Chest CT – Partial volume scanning– Automatic attenuation correction– Bismuth shielding– Chrysalis not used-scan plane too large

Breast dose reduction strategies for CT imaging

• CT Abdomen – Automatic attenuation correction– Bismuth shielding– Breast displacement/external shielding-Chrysalis

Breast dose reduction strategies for CT imaging

– Automatic attenuation correction• Widely available on all scanners• No reduction in image quality

– Prospective gating for CTCA• Limited availability

– Bismuth shielding• 35-45% dose reduction• Breasts in imaging plane• Artifacts in imaging plane

– Breast displacement/external shielding-Chrysalis• Breasts out of imaging plane• Decrease in artifacts in large breasted women• Median dose reductions (CTCA pilot study):

– Inferior lateral quadrants: 32% – Peri-areolar: 90%– Upper outer quadrants: 95%

• External shielding can be added for additional dose reduction• Reduction in dose additive to CT scanner based reduction strategies

Breast dose reduction strategies for CT imaging

– Breast displacement/external shielding-Chrysalis• Useful in exams where breast displacement practical

– CT Abdomen– CT coronary angiography– Potentially for Chest CT for Pulmonary Embolism

• Breasts are displaced upwards out of the imaging plane• Optimal displacement of peri-areolar and upper-outer

quadrants– Largest volume of radio-sensitive breast tissue

• Less tissue to traverse, increased photons at detectors• Decreased artifacts in large breasted women• Additive to other dose reduction strategies

Breast dose reduction strategies for CT imaging

• Chrysalis pilot study– 10 patients

• 5 control• 5 displaced by Chrysalis

– Patient demographics• Body mass index• Bra cup size

– OSL dosimeters placed in 4 locations in breasts• Inferior margin at chest wall• Inferior quadrant midway between nipple and chest wall• Nipple• Upper quadrant midway between nipple and chest wall

– Patient experience wearing the Chrysalis evaluated with post-procedural questionnaire

Breast dose reduction strategies for CT imaging

• Chrysalis pilot study-results– Questionnaire responses

• No shortness of breath while wearing Chrysalis• No discomfort while wearing the Chrysalis

– Responses typically were that it was quite comfortable• All patients would choose to wear the Chrysalis if it is shown

to be effective– Sample responses in control group

• “I would really like to wear the device.”• “If I come back tomorrow, could I wear the Chrysalis?”• All expressed a strong interest in being in the other group

wearing the Chrysalis

Breast dose reduction strategies for CT imaging

• Chrysalis pilot study results– BMI mean• Control group-29• Chrysalis group-43

– Bra cup size mean• Control group-B• Chrysalis group-D

Breast dose reduction strategies for CT imaging

• Chrysalis pilot study results– Radiation dose reduction-median• Inferior margin

– -1.6% left, -23.2% right

• Inferior quadrant– -30.8% left, -33.4% right

• Peri-areolar (nipple)– -87.8% left, -92.4% right

• Upper quadrant– -95.2% left, -94.5% right

Breast dose reduction strategies for CT imaging

• Chrysalis pilot study results– Intra-subject comparisons between dose at

inferior margin of the breast and upper quadrants.• Upper quadrants

– Control group» 6 of 10 measurements in the upper quadrants greater

than inferior margin– Chrysalis group

» Least dose reduction 77%, median 95.3% left, 94.0% right

Breast dose reduction strategies for CT imaging

– Bismuth shielding• Easily used• Different sizes available• Efficacy independent of breast size• 35-45% dose reduction• Breasts not displaced and remain in imaging plane• Artifacts at periphery of imaging plane• Reduction in photons through-out scan plane

% Dose Reduction Chrysalis

Responses to questionnaire after wearing the Chrysalis

Subject 6, BMI 42 Bra Cup size D

Breasts in the scan plane, Subject in Control Group Chrysalis not used

Scan plane

Subject 6, BMI 42, Bra cup size D

Breasts in the imaging plane, control group not wearing the Chrysalis

Subject 7 BMI 43 Bra cup size DDD

Breasts displaced upwards out of the scan plane by Chrysalis

Subject 7, BMI 43 Bra cup size DDD

Breasts displaced upward out of scan plane

Breasts displaced upwards out of the imaging plane by the Chrysalis

AP Topographic image comparisons between control and displaced group

Subject 5, BMI 23, Bra cup B Subject 10, BMI 33, Bra cup D

Fiducial marker

Upper and lower margins of scan planeUpper and lower margins of scan plane

Scan plane, breasts difficult to see

Lateral topographic comparisons between control and displaced group

Subject 6, Breasts not displaced, control group Subject 7, Breasts displaced by Chrysalis;

note fiducial at top of Chrysalis.

Lateral Topographic image comparisons without(Left) and with(Right) Chrysalis

Non-displaced, breasts in the imaging plane for CTCA

With Chrysalis displacement, breasts out of the imaging plane for CTCA

Nipple

Objective Image quality, matched subjectsSubject 10, with Chrysalis Subject 5, non-displaced

BMI 33 23

Bra cup size D B

SD Pulmonary Artery, HU 17.3105 23.1968

SD Left Ventricle, HU 12.4801 21.6982

SD Right Ventricle, HU 11.0587 16.4248

SD Aorta, HU 13.3271 18.6049

SD Left Atrium, HU 10.1897 23.3802

SD Fat at Chest Wall, HU 10.763 13.999

SD Left Ventric. Wall, HU 8.5911 22.8901

SD Fat Adj. to Aorta, HU 13.9555 37.6835

SD Fat Adj. to Pulm. Art., HU

14.4378 26.6073

Mean Standard Deviation 12.46 22.72

Percentage Improvement Subject with Chrysalis 45.2%

Objective Image Quality, Matched SubjectsSubject 8, with Chrysalis Subject 7, non-displaced

BMI 43 42

Bra cup size DDD D

SD Pulmonary Artery, HU 24.8906 24.

SD Left Ventricle, HU 12.948 41.3497

SD Right Ventricle, HU 12.8628 30.5553

SD Aorta, HU 22.0445 24.6378

SD Left Atrium, HU 19.9608 26.676

SD Fat at Chest Wall, HU 16.094 38.8654

SD Left Ventric. Wall, HU 13.0595 30.9426

SD Fat Adj. to Aorta, HU 27.6986 35.2194

SD Fat Adj. to Pulm. Artery, HU

25.6866 32.1756

Mean ROI 19.47 31.56

Percentage Improvement Subject with Chrysalis 38.3%

Left main, 0.5 mm thickness

BMI 43 Bra cup size DDD

Axial Image comparisons, without and with Chrysalis

Subject 6, BMI 42, D Cup Left Main, 0.5 mm reconwithout Chrysalis, note graininess of images and ill-defined edges

Subject 7, BMI 43, DDD Cup Left Main, 0.5 mm recon with Chrysalis, note images less grainy and with sharper margins

Axial Image comparisons, without and with Chrysalis

Subject 6, BMI 42, D Cup RCA, 0.5 mm reconwithout Chrysalis-fuzzy edges, grainy

Subject 7, BMI 43, DDD Cup RCA, 0.5 mm recon with Chrysalis-sharp edges, smooth

Axial Image comparisons without and with Chrysalis

Subject 5, BMI 23, Bra cup B Non-displaced control group, note less well-defined margins and inhomogeneous contrast –filled spaces

Subject 10, BMI 33, Bra cup D Chrysalis displaced group, note sharp edges of LAD and smooth contrast-filled spaces

CT Abdomen, Need for Displacement

Breasts over-lapping upper abdomen- Note upper right lobe of liver, large

amount of breast tissue, and bismuth shielding

CT Abdomen, note lower breasts over-lapping the upper abdomen

How much Breast dose reduction do you need?

Why leave the breasts in the imaging plane when they can be

displaced?

Don’t expose the breasts, displace them instead

Include the Chrysalis in your CT Dose reduction program

The Chrysalis breast displacement management system.

Contact: Charles M Swaney, MD573-886-8936(O)573-864-2603(C)