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A Significant Investment in Canon Medical CT

February 7, 2022

VISIONS spoke with Dr. Frédéric Alexis (Head of the Radiology department at Sainte Elisabeth Clinic, Namur, Belgium) about the experiences with Canon Medical's CT systems; the Aquilion Lightning SP, the Aquilion ONE / PRISM Edition, and the Aquilion Precision.

The Sainte Elisabeth Clinic is one of three hospitals that comprise the CHU UCL University Hospital in Namur, Belgium. The Clinic specializes in oncology and radiotherapy, maxillofacial surgery, implantology and weight-loss surgery, but is also active with other medical and surgical disciplines, including interventional cardiology, dialysis, maternity care and pediatrics. It has recently acquired three CT scanners from Canon Medical, including the first Aquilion Precision in Belgium. Dr. Frédéric Alexis, Head of Radiology at the Clinic, explained how the systems are not only supporting better diagnostic confidence, but also enabling new research.
The Sainte Elisabeth Clinic in Namur, Belgium, has acquired an Aquilion Lightning SP, an Aquilion ONE / PRISM Edition and an Aquilion Precision.
Sainte Elisabeth Clinic, Namur, Belgium.

Which factors were particularly important in choosing new CT scanners?

As we perform a great number of pain clinic and peri-rachidial infiltrations, biopsies, and drainage of fluid collections, we were looking for a scanner for interventional imaging.

We also required scanners with the widest anatomical coverage for perfusion, cardiac imaging, and ‘difficult’ patients, such as elderly people or children, or those with dyspnea. In addition, all our CTs require a large gantry to enable interventional imaging, diagnosis and treatment of bariatric and Intensive Care patients.
Sainte Elisabeth Clinic, Namur, Belgium.
Technically, we wanted one of the devices to be equipped with Spectral imaging, and we also wanted to obtain the best spatial resolution.

Ease-of-use for technologists was a very important factor, as well as comfort for patients and technologists. Great capabilities and fast post-processing were also key needs.

Why did you choose these particular scanners from Canon Medical Systems?

The Aquilion Lightning SP, the Aquilion Precision and the Aquilion ONE / PRISM Edition scanners utilize a similar user interface for image acquisition, the same image production chain, and the same qualitative components. All of them have Advanced intelligent Clear-IQ Engine (AiCE) reconstruction, a large gantry, and are patient-friendly, providing lateral table movement and a very low table height, which is ideal for patients with reduced mobility.

They also offer wide anatomical coverage, which is especially useful for cardiac imaging and cerebral perfusion (as required in cases of stroke). And high resolution for bone and oncology imaging.

Canon Medical offers such high professional standards in all components of its products and services; from technology to construction of the products, and from installation to support.
The Aquilion Lightning SP.

What did you expect the systems to bring in terms of improvements in daily practice?

Firstly, we anticipated that they would help ease and harmonize the acquisition of examinations for the technologists, thanks to the common user interface of the three CT systems.

We were expecting fast and efficient post-processing, and user-friendly features. It was important for us to be able to work with reduced dose, or improved image quality. We were also looking forward to exploring spectral imaging.
A COVID-19 appropriate inauguration of the first Aquilion Precision in Belgium took place on 29 June 2021.

The representatives of Canon Medical during this inauguration where: Kristoff Reyntjens (General Manager at Canon Medical Systems Belgium), Roy Verlaan (European Modality Director CT at Canon Medical Systems Europe), René Degros (Vice President Sales & Marketing at Canon Medical Systems Europe) and Mr. Tetsuya Kawagishi (President and CEO at Canon Medical Systems Europe).

Have the Canon Medical scanners met these expectations?

Yes. Thanks to training of our technologists that began before the arrival of the scanners, we were able to facilitate rapid use of the new equipment by the majority of our staff that need to use the systems. Other staff were introduced later with progressive installation of the systems.

We have been able to develop common examination protocols, but also specific protocols for each system, for example, for use in Ultra-High resolution Ear Nose and Throat (ENT), Musculoskeletal (MSK), and in Oncology for the Aquilion Precision.

We have developed protocols in oncology, vascular, cardiac, perfusion and spectral imaging for the Aquilion ONE / PRISM Edition and Interventional imaging for the Aquilion Lightning SP.

The availability of AiCE on each system guarantees improved image quality and a reduction in radiation dose.

Cardiac examinations have particularly improved, in terms of dose and image quality, even for patients with high heart rates, or when we are not able to use beta-blockers. The Vitrea coronary CTA post-processing is fast and robust. For Interventional procedures, the joystick is easy of use for Dr. Peter Verbeek, (future head of departement and MSK diagnostic and interventionnal radiologist) - it is more precise and responsive than previous systems, not exposes to any radiation.

“Canon Medical offers such high professional standards in all components of its products and services; from technology to construction of the products, and from installation to support.”

Dr. Frédéric Alexis, Head of the Radiology department at Sainte Elisabeth Clinic, Namur, Belgium.

What is the most significant difference that AiCE has made to your practice?

It clearly improves the quality of the images and reduces the dose of the examinations.

There is less noise, even at low dose, with preserved or improved image quality. This brings us more diagnostic confidence.

M. Thomas Solot, CT Lead CT Technologist at the Sainte Elisabeth Clinic in Namur, Belgium.

How does AiCE improve the image quality?

As a denoiser, the algorithms used improve contrast resolution and image quality. Without dose optimization, image quality is excellent. If you optimize the radiation dose, the quality remains very good, but allows us to scan effectively with low dose. After a few months of use, the average dose of the examinations decreased by 46% with possibilities for optimization, with an maximum dose reduction of 80% in cardiac imaging. In ideal rythm and patient conditions the dose can drop under DLP under 40!

Dr. Peter Verbeek, (new) Head of Radiology Department at the Sainte Elisabeth Clinic in Namur, Belgium.

How was adoption of AiCE with your staff?

It is an ongoing learning and evaluation process. They have adapted to the new procedures and learned how to optimize parameters and appreciate the improvements in images compared to our old scanners.

Dr. Sergio Pestieau, MSK Radiologist at the Sainte Elisabeth Clinic in Namur, Belgium.

What are the advantages of using high resolution images acquired with the Aquilion Precision?

We have already been able to acquire detailed studies of bone structures, small vascular anomalies, particularly neurological ones (for Arteriovenous Malformation (AVM), aneurysms etc.), the sinuses, and the fine structures of the temporal bone. Stent imaging for coronary arteries and other small vessels is now better. With these high-quality imaging capabilities, we hope to improve surgical tumor extension assessments, especially for pancreatic and lung cancer.

Dr. Hélène Antoine, Neuro – ORL Radiologist at the Sainte Elisabeth Clinic in Namur, Belgium.

Cone Beam CT (CBCT) also offers high-resolution imaging. How do you compare the two technologies?

Our CBCT is mainly used for high resolution at low dose for examinations of maxillofacial, dental and ENT (for sinus and temporal bone) pathology, and bone structures of the extremities.

It allows resolution from 150 to 75 microns. The lower contrast resolution does not allow the study of the soft tissue.

With the Aquilion Precision we are able to image bone structures at high resolution with a dose that begins to compete with CBCT with soft tissue contrast.

For example, the CT Dose Index (CTDI) for temporal bone CBCT is 21 mGy and we have developed a protocol with the Aquilion Precision at a dose of 30 mGy with the same spatial resolution of 150 microns.

Dr. Marie Gheur, Thoraco abdominal Radiologist at the Sainte Elisabeth Clinic in Namur, Belgium.

For what clinical indications do you use the spectral technology from Canon Medical Systems?

Oncologic patients, emergency mostly ischemic and hemorrhagic situations, characterization of renal lesion especially atypical cystic lesions and urinary stone characterization. It also gives us better depiction of contrast extravasation for EVAR-TEVAR follow up.

M. Didier Vandeput, Chief Technologist of the Medical Imaging Department at at the Sainte Elisabeth Clinic in Namur, Belgium.

How does spectral analysis contribute to better diagnosis in clinical practice?

We can avoid irradiation from non-contrast acquisition, reduce the amount of iodine contrast media required and combine arterial and portal enhancement at different kVps.

It provides better depiction of contrast uptake, or absence of it, in cases of pathology (for oncology or ischemia).

How would you describe your collaboration with Canon Medical Systems?

From start to finish, the support from Canon Medical has always been very professional, whether it was for the room construction and fitting-out teams, the device assembly team, or the engineers for the maintenance of the machines. The involvement and commitment of Canon’s Managers was also appreciated. We continue to work closely with Canon Medical’s Belgian and European Application staff to improve examinations and post-processing. //
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