Revolutionising medical imaging: A new era
The integration of AI with advanced imaging technologies offers more accurate, efficient and safer solutions to improve patient outcomes
WE LIVE in an era where technological advancements in medical imaging have transformed the way doctors diagnose diseases, enabling earlier detection and significantly improving patient outcomes. Photon Counting Computed Tomography (PCCT) has emerged as a groundbreaking innovation, offering substantial improvements over traditional computed tomography (CT) systems. As a state-of-the-art imaging technique, PCCT is poised to revolutionise diagnostic medicine by enhancing the accuracy, efficiency and safety of medical assessments.
Photon Counting Computed Tomography (PCCT)
Traditional CT scanners use detectors that employ a two-step process to average the energy of photons (particles of electromagnetic radiation) generated during X-ray imaging. Imagine mixing different shades of yellow together to create a single, uniform yellow – this represents the averaging process in conventional CT.
In contrast, PCCT utilises specialised detectors capable of directly detecting individual photons during an X-ray scan, allowing for more precise energy discrimination. To extend the analogy, PCCT records all the variations of yellow, preserving their distinct differences, resulting in higher resolution images and more accurate tissue characterisation (multispectral imaging).
Enhanced image quality
One commonly ordered diagnostic test is the Coronary Artery Calcium Score, also known as the calcium score, which evaluates the amount of calcium build-up in coronary arteries. A calcium score above 400 indicates significant plaque buildup and the patient faces a high risk of heart attack or stroke. To better visualise coronary artery narrowing, a CT Coronary Angiogram (CTCA) may be used to produce three-dimensional (3D) images of the arteries.
The presence of calcium deposits in the coronary arteries can affect the accuracy of CTCA by causing “blooming artifacts” – where small, high-density objects, like artery calcifications, appear larger than their true size, potentially leading to an overestimation of narrowing.
One of the most significant advantages of PCCT is its ability to produce higher-resolution images, overcoming the limitations of traditional CT. This enables clearer and more accurate visualisation of coronary arteries, even in the presence of calcification, ultimately reducing the need for unnecessary invasive procedures.
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Improved diagnostic accuracy
PCCT outperforms traditional CT in its ability to distinguish between different types of tissues and materials. A key challenge in CTCA is evaluating coronary arteries that contain metal stents, which are often made from alloys or stainless steel. These materials can create multiple artifacts in conventional CT scans. With its higher resolution and artifact reduction, PCCT can provide a clearer image of coronary stents, improving diagnostic accuracy.
In oncology, PCCT holds promise for detecting and characterising tumours with greater precision. With the ability to detect tumours as small as 0.2 mm, PCCT helps identify cancers that might be missed by conventional CT. Its multispectral imaging capabilities are also a game-changer, capturing images at various energy levels and providing valuable information about tissue composition. This enables more accurate differentiation between benign and malignant tissues, aiding in improved staging and treatment planning.
The integration of artificial intelligence (AI) and machine learning with high-resolution, multispectral PCCT promises to further enhance image interpretation and diagnostic workflows. AI algorithms can assist radiologists in detecting patterns and anomalies in PCCT images, increasing diagnostic efficiency and accuracy.
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Lower radiation dose
An additional benefit of PCCT is its potential to reduce radiation exposure to patients. For instance, an adult, who had been vaping regularly, came in for a lung scan. The PCCT revealed early signs of lung damage. This scan had a minimal radiation dose equivalent to just two chest X-rays, which was far less than the radiation dose from a conventional CT. Early detection of lung damage helped the patient make the decision to quit vaping, preventing further harm to her lungs.
High Tesla Magnetic Resonance Imaging (MRI)
Currently, the highest commercially available MRI scanner is the 7 Tesla MRI, approved by the US Food and Drug Administration in 2023 for brain and knee imaging. For context, a refrigerator magnet has a magnetic field strength of approximately 0.001 Tesla. While 7 Tesla MRIs are not yet widely used due to limitations, 3 Tesla (3T) MRIs are a clinically established option.
Improving accuracy with AI-powered MRI
AI-powered 3T MRI imaging, such as the Neuroquant system, offers significant advancements in the detection and early diagnosis of neurodegenerative diseases like Alzheimer’s disease (AD). Early identification of cognitive impairment enables timely intervention and treatment. Neuroquant uses deep learning-based technology to accurately detect and quantify even the smallest brain lesions, and monitor treatment effects in AD patients. Given the rising prevalence of dementia in aging populations, this technology will play a crucial role in diagnosing and managing neurodegenerative diseases.
Another common condition among older adults is musculoskeletal degeneration, especially knee joint degeneration. AI-powered 3T MRI systems, such as Chondral Quant, offer precise 3D assessments of knee cartilage and can identify early cartilage degeneration. Early intervention in osteoarthritis can help maintain mobility and delay or even prevent the need for surgery.
Functional MRI (fMRI), which measures brain activity through blood flow changes, is another exciting development. fMRI is currently used for pre-surgical brain mapping, evaluating psychological changes and assessing the effects of therapy on the brain. It is also useful for studying depression in elderly individuals, as MRI scans can identify structural and functional changes in the brain associated with Major Depressive Disorder (MDD). While not diagnostic on its own, fMRI can provide crucial information that helps predict how patients will respond to treatment.
Furthermore, for elderly men experiencing urinary issues related to prostate enlargement, a 3T MRI using the internationally recognised PI-RADS protocol offers highly accurate assessments to differentiate between benign prostate enlargement and potential prostate cancer.
AI-powered future
A new era in medical imaging is upon us, driven by AI-powered PCCT and high Tesla MRI technologies. For patients suspected of heart artery blockage or those with heart stents, PCCT provides highly accurate scans that significantly reduce the need for invasive procedures. The exceptional resolution and multispectral capabilities of PCCT allow for early detection of tumours as small as 2 mm, better tissue characterisation, and more precise cancer detection.
For smokers at risk of lung disease, PCCT offers early detection of lung tumours with a minimal radiation dose, equating to only two chest X-rays. In older populations, high Tesla MRI technologies are enabling the early identification of conditions such as mild cognitive impairment, osteoarthritis, and other age-related ailments, ultimately improving quality of life through early intervention.
In conclusion, the integration of AI with advanced imaging technologies like PCCT and high Tesla MRI systems is ushering in a new era of medical diagnostics, offering more accurate, efficient and safer solutions to improve patient outcomes.
In my personal experience with PCCT and 3T MRI, it is clear that the full potential of these imaging innovations can only be fully realised if there is a dedicated, highly-driven imaging team constantly driven to ride the AI-powered medical imaging revolution. With the potential to detect diseases earlier, guide treatment decisions and reduce the need for invasive procedures, these innovations are poised to revolutionise the field of medical imaging.
This article is part of a monthly series on health and well-being, produced in collaboration with Royal Healthcare
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