In old Egypt, 5 000 years ago, physicians examined the different parts of the body to evaluate elasticity, they knew that a hard mass in an organ is pathologic


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In old Egypt, 5 000 years ago, physicians examined the different parts of the body to evaluate elasticity, they knew that a hard mass in an organ is pathologic.

  • In old Egypt, 5 000 years ago, physicians examined the different parts of the body to evaluate elasticity, they knew that a hard mass in an organ is pathologic.

  • In Greek ancient age, for Hippocratic medicine, palpating was an essential time of physical examination.

  • In 21st century, imaging take preeminent place in medicine and Elastography could be considered as an « imaging palpation »…



Elastography is an imaging technique to measure the stiffness of tissues.

  • Elastography is an imaging technique to measure the stiffness of tissues.

  • Images are acquired before and after soft compression of tissues and the deformation is evaluated.

  • Initially elastography used manual compression and was only qualitative, now some methods appears to apply a non operator dependant compression.



Elastography was developed first in the US field.

  • Elastography was developed first in the US field.

  • Three step approach:

    • Organs mechanically stressed by either external or internal forces.
    • Measurement of tissues movement induced.
    • Qualitative or quantitative evaluation of tissue elastic properties from the measured displacement of tissues.


Manual compression by operator using the transducer (static elastography).

  • Manual compression by operator using the transducer (static elastography).

  • Organ compression by heartbeat or vascular pulsations.

  • Push pulse waves compression.

  • Supersonic shear waves.



















Compression/Decompression Movements







Significant difference benign versus malign:

  • Significant difference benign versus malign:

    • Cancers: E = 170.1 ± 41.6 kPa
    • Benign lesions: E = 53.5 ± 19.8 kPa










Breast

  • Breast

  • Thyroid

  • Liver

  • Prostate



Now, several vendors are coming on the market:

  • Now, several vendors are coming on the market:

    • Until 2008: 1 vendor had products for sale.
    • 2008: 3 vendors.
    • 2009: several announcements  6 vendors or more.
    • … probably every US vendor at short term.
  • At this time, only secondary capture or US objects.

  • All specific information to elastography are lost.



More and more clinical applications.

  • More and more clinical applications.

  • New BI-RADS edition, planned for 2010, will take into account US elastography for breast imaging.

  • Users would like to be able to store elastography information in their PACS:

    • Additional attributes in US objects?
    • New objects?
  • Some pathology needs elastography follow-up:

  •  Probably DICOM SR templates needed



Elastography is US  WG 12

  • Elastography is US  WG 12

  • Elastography for Breast imaging  WG 15

  • Elastography needs DICOM SR templates  WG 8

  • Other?



A motion to ask the concerned WG to investigate the domain to determine if further works needed?

  • A motion to ask the concerned WG to investigate the domain to determine if further works needed?

  • Report to DICOM Standards Committee?



And after?

  • And after?








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