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 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

• Compression/Decompression Movements

• Displacement speed measurement
• Integral -> Elasticity

• Elasto Q Mode

• Information at decompression
• Automatic selection of the best cycle
• ROI on fat and lesion
• Quantification

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?