Recently, not only has echocardiography progressed but the social situation that surrounds medical services has also changed. Each medical institution has been gradually developing a network system for echocardiography, because the information yielded by echocardiography should be managed effectively and safely. In this report, we have described network-system building for echocardiography using “Xcelera” by Philips on the basis of our experiments.

View full abstract

The problems with digital storage in echocardiography had been the high costs and the large size of data files for several decades. These problems have recently been solved by improvement in technology, with digital data in echocardiography now being archived as digital imaging and communications in medicine (DICOM) and reviewed in the patient's digital medical record. Moreover, the standard DICOM structured reporting supports data input to a digital reporting system regardless of the ultrasound machine or its maker. The echo filing system Xi2^TM (GE Healthcare) allows archiving of echo data from many different areas of a hospital, such as department of laboratory medicine, emergency room or pediatrics. These data and reports can be reviewed in the patient's digital medical record anywhere in the hospital. The benefits of this system are: 1) reducing examination time, 2) archiving of echo data including the acute phase, 3) sharing information among the members of the medical team, and 4) facilitating explanation of echocardiographic findings to the patient. This system offers high clinical efficiency.

View full abstract

Prior to introduction of Picture Archiving and Communication System (PACS), echocardiography images were recorded and stored on videotapes as analog data. Reports were created manually and stored within a patient's medical record. But recent widespread use of digital media such as CDs, DVDs, and DICOM servers enables storage of high-quality, large-volume data easily. Also, Electrical Medical Record (EMR) technology requires a digital filing system for both images and reports to review information from the client PC on the system. The echocardiography image and report filing system at our facility is called ProSolv CardioVascular, which was developed based on the concepts of Dr. Feigenbaum. ProSolv is now a part of Fuji Film, and the system has become a comprehensive cardiology image and report filing system. The system is capable of storing other cardiology-related data (e.g., X-ray, nuclear medicine), and the information can be reviewed from the EMR. SYNAPSE Cardiovascular stores high-quality still and motion images that can be easily reviewed at the client workstations, and reports can be generated easily and precisely. SYNAPSE Cardiovascular is a dedicated PACS system for cardiology practice. The system provides an environment for users to be able to review any echocardiography images and reports from anywhere in the hospital for prompt diagnosis and access to medical information.

View full abstract

At the University of Tokyo Hospital, centralization of cardiovascular, abdominal, and thyroid ultrasound examinations was completed in 2006, and all these examinations have been performed in the Department of Laboratory Medicine. Simultaneously, an online ultrasound image work-system (EchoAgent, TOSHIBA Medical Systems Corporation) was launched so that important ultrasound data can be archived and reviewed, and reports can be created easily. Merits: The merits of this system are as follows: 1) The number of ultrasound examinations increased steadily year by year, 2) patient management became much more efficient, 3) use of old media such as videotapes and papers could be abolished, and 4) clinical research studies were promoted. Problems: Initially, problems requiring solutions were as follows: 1) Slow processing speed, 2) lack of a search function and statistical function, and 3) inability to review movie files on PC for medical use. Of the above three problems, 2) and 3) have been solved. Although the processing speed has been greatly improved, it is still a problem. Furthermore, the cost of maintenance and system updates is now a significant problem requiring a solution.

View full abstract

Purpose: To evaluate post-mortem ultrasonography for diagnosing acute aortic dissection (AAD) as the cause of death. Subjects and Methods: The cause of death had been diagnosed as AAD in 34 of 378 post-mortem examinations performed during the period from 2007 to 2010. In 26 of the 34 cases, a portable ultrasonographic device was used for diagnosis as autopsy ultrasonography. Ultrasonographic findings were evaluated as well as the clinical course and diagnosis. Results and Discussion: Cases of AAD are increasing in number year to year. Seventy-seven percent of AAD cases were over 70 years old. In terms of initial symptoms, syncope or consciousness disturbance was seen in 18 cases, chest or back pain was found in eight cases, and vomiting was noted in one case. Twenty-three cases were brought to the emergency room, and 22 cases suffered cardio-pulmonary-arrest. Twenty-six cases of AAD were diagnosed based on the clinical course, chest x-ray, or autopsy ultrasonography findings. In five cases in 2010, CT was also used in the diagnosis. At our institution, autopsy ultrasonography was first used for post-mortem examinations in 2007. In the initial stage, only pleural effusion was revealed in cases of AAD. Since March 2010, observation from the upper edge of the clavicle and the right edge of the sternum, dilated ascending aorta, and intimal flap was realized directly in 17 cases of AAD. Conclusion: Autopsy ultrasonography was useful for diagnosis of AAD.

View full abstract

Since examinations with echography largely depend on the expertise and experience of the operator, many kinds of techniques for recognizing the left ventricular (LV) cavity have been developed. However, most of these techniques require initial settings to indicate the initial region or points of interest of the examiner. Thus, an automatic diagnosis support system without initial settings has the potential not only to save time when analyzing large amounts of data but also to reduce the burden of doctors or sonographers. Therefore, we have developed automatic recognition software for the LV cavity that does not require initial settings. The software consists of two processes. The first process is the automatic detection of the inner area of the LV cavity, which includes calculation of the motion vectors from the ventricular wall and calculation of intersection points from multiple combinations of vectors. The second process is the automatic recognition of the LV cavity, which includes the approximation of the shape of the LV to ellipsoid by centering the gravity point of the intersection points, and the determination of the LV cavity without the mitral valve and the nipple muscle. We have applied this algorithm to 50 diseased hearts. The proposed method correctly recognized LV cavities with an 89% recognition rate in 36 cases, where 14 severe cases were excluded. Furthermore, the results of ejection fraction calculation agreed with those yielded by the conventional method performed by professional sonographers, with a correlation coefficient of 0.82.

View full abstract

Purpose: Because measurement errors are caused by the Doppler incident angle in ultrasound velocity estimation, it is said that the incident angle should be within 60 degrees. However, previous reports showed that if the incident angle was within 60 degrees or less, the measurements were greater than the actual velocity. We reevaluated overestimation of velocity with the Doppler incident angle. Methods: A string phantom was installed in a water tank and set at a constant speed of 100 cm/s. The ultrasound linear-array transducer was adjusted so that the incident angles were 45 degrees, 50 degrees, and 60 degrees. The transducer was fixed in a state where a measurement error did not appear. The velocities of the string phantom were measured at the Doppler incident angle of 45 degrees, 50 degrees, and 60 degrees three times, respectively. Results: The means of peak velocity at the incident angle of 45 degrees, 50 degrees, and 60 degrees were 120.1 cm/s, 124.2 cm/s, and 135.2 cm/s, respectively. Even with an incident angle of 45 degrees, the overestimation of velocity was approximately 20%. As the incident angle became larger, the overestimation of velocity increased. Conclusion: Even if the incident angle is 60 degrees or less, flow velocity may be overestimated.

View full abstract