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Diagnosing Tuberculosis: The Limitations of Common Procedures, and How Reveal™ 35C Can Help

Tuberculosis (TB) is an infectious disease that occurs in every part of the world. It is spread through airborne bacteria from one person to the next without physical contact.
  

Although cases are relatively low in Canada and the US, in 2019 alone, 1.4 million people died from TB worldwide5. Tuberculosis is latent in most cases, but approximately 5% of people who are exposed end up with active infections that could be fatal5.
  

Since TB is preventable and curable, the World Health Organization aims to eliminate it by 2030. They estimate that 60 million lives have been saved globally through TB diagnosis and treatment between 2000 and 20195.
  

It is critical that tuberculosis be reported and treated in a timely fashion to prevent the spread of infection. Initial diagnosis is made by reviewing case history, blood and skin tests, with chest X-ray and computed tomography (CT) used to follow up, if accessible. Treatment begins with antibiotic medication that can span many months. 

According to a study published in 2015, chest radiography plays a major role in diagnosing and monitoring TB3. Recently, the World Health Organization (WHO) also issued guidance recommending the use of chest X-ray to initially screen for TB7.

 

Here are 3 issues to consider when using X-ray imaging:
 

Problem 1: Quality
 

X-ray is not effective in finding consolidation and cavitation, which are key signs of TB infection in the chest. Conventional X-ray imaging technology is thus inaccurate and unreliable for screening TB. Computed tomography scans are much more accurate, but these are not accessible in the parts of the world suffering from TB. 

 

How Reveal™ 35C can help:
  

Reveal 35C, a dual-energy subtraction X-ray, enables bone and tissue differentiation without motion artifacts in a single shot. It provides radiologists with three images, a high–quality X-ray, a bone-subtracted one, and a tissue-subtracted image. The bone-subtracted image in particular has been demonstrated in a clinical study3 to find more consolidation and cavitation than a standard digital X-ray and also to have a large negative predictive value. This allows more accurate detection of tuberculosis especially for screening.

Problem 2: Availability/Cost 

 

While X-ray technology is widely accessible in countries with a high prevalence of TB, there is almost always a challenge in accessing CT especially in remote locations. There are fewer machines and fewer hospitals and clinics that have them and CT is not portable.
  

In many areas of the world, CT technology is not an option at all. There are a limited number, if any, scanners available. This is mainly due to lack of funding. Although X-ray technology cannot replace CT, a more advanced X-ray can aid in diagnosis and portability provides the much–needed accessibility for remote locations.
 

How Reveal 35C can help:
  

Reveal 35C dual-energy X-ray detector is easily retrofittable into most portable and fixed X-ray systems. Reveal 35C is portable and can be taken right to a patient’s bedside or alternately, to the village. Reveal 35C provides a standard chest X-ray alongside bone and tissue images in just one shot, saving time and X-ray dose. It allows for faster reading and aids radiologists especially with difficult cases involving consolidation and cavitation.
  

Not only is Reveal 35C portable, it is available at less than a quarter of the price of other fixed dual-energy systems and can be used with any existing X-ray system reducing the need for large capital expenditures.
  

Problem 3: Radiation Dose
 

X-ray is the preferred method of diagnostic imaging for diagnosing TB, especially as a first step, due the lower dose of radiation used. Chest X-rays typically produce about 0.1 mSv of radiation1 which is well within the recommended public dose limit per year of 1 mSv1. CT scans require anywhere from 20-50X the radiation of a chest X-ray and thus, cannot be used as a screening tool for patients.
  

How Reveal 35C can help: 

 

Reveal 35C provides very high DQE digital radiography images, differentiates bone and soft tissue while maintaining the same exposure to radiation as a chest X-ray. 
  

Reveal 35C and TB:

 

KA Imaging was featured in a report about digital chest radiography and computer-aided detection solutions by the Foundation for Innovative New Diagnostics (FIND)6. They explored the market of radiology solutions for screening TB in order to help readers understand the different options and recognized the many benefits of using Reveal 35C in a TB screening application. 

 

Learn more about Reveal 35C through the button below:

 



Reveal Brochure


References 

  1. 3. Sharma, M., Sandhu, M. S., et al. (2015) Role of digital tomosynthesis and dual energy subtractions digital radiography in detection of parenchymal lesions in active pulmonary tuberculosis. European Journal of Radiology. Tuberculosis. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/tuberculosis/symptoms-causes/syc-20351250 

  1. 4. Tuberculosis: Symptoms and treatment Government of Canada – https://www.canada.ca/en/public-health/services/diseases/tuberculosis.html 

  1. 5. Tuberculosis. World Health Organization https://www.who.int/news-room/fact-sheets/detail/tuberculosis 

  1. 6. Digital Chest Radiography and Computer-Aided Detection (CAD) Solutions for Tuberculosis Diagnostics. Foundation for Innovative New Diagnostics. Retrieves March 30, 2021 from https://www.finddx.org/wp-content/uploads/2021/04/FIND-CXR-CAD-solutions-for-TB-diagnosis-7Apr2021.pdf 

  1. 7. WHO Library Cataloguing-in-Publication Data. Chest Radiography in Tuberculosis Detection – Summary of Current WHO Recommendations and Guidance on Programmatic Approaches. I. World Health Organization. ISBN 978 92 4 151159 th

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“Breaking Boundaries” to Help Veterans through Innovation

KA Imaging Pitches Reveal™ 35C Technology
 

KA Imaging is eager to pitch their solution for previous X-ray technology shortfalls on August 26, after being selected to take part in the Breaking Boundaries Collaboration Challenge. This online competition will provide the opportunity for selected winners to work with both public and private sectors and advance healthcare resources provided to U.S. Veterans.
  

For KA Imaging, this would mean bringing Reveal™ 35C, the world’s first portable dual-energy X-ray detector, to emergency departments in order to help diagnose pneumonia, including COVID-19. The need for better imaging and faster more accurate diagnoses has increased greatly during these pandemic times. KA Imaging wants to help, learn, and bring innovative X-ray everywhere.
  

Reveal 35C chest imaging can be used in different applications. Dual-energy technology is clinically proven to aid the diagnosis of lung cancer1, pneumothorax2, and cardiac disease3. The dual energy technology improves accuracy of X-ray4, leading to the early detection of disease and injury, helping patients, and providing more efficient healthcare.
  

The Veterans Health Administration (VHA) is described as the largest integrated health care system in the Unites States, with health care facilities and medical centers, programs, services, and much more, all to support millions of people who served in the military.
 

The VHA Innovation Ecosystem (IE), in partnership with the Founder Institute and Innovators Network (iNET), launched the Breaking Boundaries Challenge as part of a series of events leading up to the VHA Innovation Experience (iEX) on October 27 and 28, 2021.  

 

References
 

  1. 1. Oda, Seitaro, Kazuo Awai, Yoshinori Funama, Daisuke Utsunomiya, Yumi Yanaga, Koichi Kawanaka, Takeshi Nakaura et al. “Detection of small pulmonary nodules on chest radiographs: efficacy of dual-energy subtraction technique using flat-panel detector chest radiography.” Clinical radiology 65, no. 8 (2010): 609-615.  

  1. 2. Martini, Katarina, Marco Baessler, Stephen Baumueller and Thomas Frauenfelder. “Diagnostic accuracy and added value of dual-energy subtraction radiography compared to standard conventional radiography using computed tomography as standard of reference.” PloS one 12, 3 (2019): e0174285  

  1. 3. Song, Yingnan, Hao Wu Di Wen, Bo Zhu. Philipp Graner, Leslie Ciancibello, Haran Rajeswaran et al. “Detection of coronary calcifications with dual energy chest X-rays: clinical evaluation.” The International Journal of Cardiovascular Imaging (2020): 1-8.  

  1. 4. Li, Feng, Roger Engelmann, Lorenzo L. Pesce, Kunio Doi, Charles E. Metz, and Heber MacMahon. “Small lung cancers: improved detection by use of bone suppression imaging-comparison with dual-energy subtraction chest radiography.” Radiology 261, no. 3 (2011): 937-949. 

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6 Reasons Why There is More to Reveal

It has been an exciting time for KA Imaging, having presented the first portable dual-energy X-ray detector to the world in 2018. In September 2020, after a great deal of dedicated work, Reveal™ 35C was granted both USA FDA 510 (k) clearance and a Health Canada Medical Device Licence which now enables the company to accomplish our marketing goals.

Reveal 35C’s unique technology is a benefit to any hospital or practice, and here are the top six reasons why:
 

  1. 1. Reveal 35C uses dual-energy subtraction radiography.
     

Dual energy subtraction X-rays subtract the bones so that the lungs can be seen clearly in one view, and subtract the lungs so the bones can be seen clearly in another view. The differences in the degree to which body tissues attenuate low and high-energy photons are used to generate these tissue-selective images. This ability to subtract tissues leads to superior sensitivity in not only finding pulmonary abnormalities such as pneumothoraces hiding behind ribs but also in characterizing pulmonary nodules as calcified or not. Dual energy can help find and identify hidden nodules and masses, discover abnormalities associated with pneumonia, tuberculosis and pneumothorax, confirm placement of indwelling devices as well as localize tumors prior to image guided therapy. 
 

  1. 2. One exposure produces three images.
     

With one shot, Reveal 35C provides a high-quality traditional X-ray, a bone-subtracted image, and a tissue-subtracted one. This is due to the unique triple-stacked layer design which allows for easy integration and high dose efficiency.
 

  1. 3. Images are free from motion artifacts.
     

The design also eliminates motion artifacts from the images. Motion artifacts are streaks that occur due to unavoidable motion due to the beating heart. Artifacts can invalidate images and mislead radiologists.
 

  1. 4. DQE is as high as 75%.
     

Detective Quantum Efficiency (DQE) measures exactly how many X-rays are captured and converted to high-quality images. A higher DQE requires less radiation to produce a better image, so a patient is not exposed in the same capacity. In comparison, a conventional Computed Radiography (CR) system may have a DQE of 40%, and DR systems can reach efficiencies of 65%1.
 

  1. 5. It is retrofittable. 

Reveal 35C can be retrofitted into any existing X-ray equipment within a few hours. There are more than 10,000 conventional X-ray systems installed in Canada, 37,6611 in the U.S. and approximately 500,000 globally. There is no need to purchase an entire new system, Reveal 35C is available at a portion of the cost.

     6. It is portable. 

 Reveal 35C can also be taken right to a patient’s bedside, saving time, and providing precautions for patients in an emergency care or critical care setting. This is especially important during pandemic times when there is a critical need for imaging at the point of care. Patients who can stay in one location would have a reduced risk of exposure to COVID-19 compared to those who have to be transported through a hospital to different departments.
   

Reveal 35C is already being used at two clinical sites in Canada (Kitchener and Toronto), with promising early results. The application of Reveal for use in diagnosing COVID-19 pneumonia is of particular significance now, and KA Imaging anticipates much more to come for this technology. 

 

 

References

1. Jones, J., Pacifici, S., et al. Detective Quantum Efficiency. Radiopaedia. https://radiopaedia.org/articles/detective-quantum-efficiency-1 

2. Kuhlman, J., Collins, J., Brooks, G., et al. (2006) Dual-Energy Subtraction Chest Radiography: What to Look for Beyond Calcified Nodules. RadioGraphics, Vol. 26, No.1. https://pubs.rsna.org/doi/full/10.1148/rg.261055034 

3. Rashidian, B. (2013) DQE, A Simplified View. https://docs.google.com/file/d/0B3r3Dioh2FdSQ1pYM2JSMU13SEE/edit?pli=1 


  

 

 

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Imaging Physicist/Engineer Presents Poster at AAPM Annual Meeting 2021

Standardization and Innovation

KA Imaging’s Sebastian Maurino, Imaging Physicist, Engineer, and Imaging Research Team Lead, presented a poster virtually at the American Association of Physicists in Medicine (AAPM) Annual Meeting 2021, titled Dual-energy Subtraction Efficiency: Development of an Objective Quality Metric for Tissue-subtraction Radiography.

The research proposed a new metric that incorporates the quantitative and qualitative properties of tissue cancellation using an experimental phantom approach. An analytical method for computing this metric was presented and verified in a variety of scenarios that attempt to simulate clinical situations.

The proposed Dual-energy Subtraction Efficiency (DSE) metric described a multitude of image properties to evaluate image quality consistently across a variety of dual energy X-ray techniques. This DSE and its measurement method show that it is possible to extend objective X-ray system evaluation to include dual-energy subtraction radiography.

 

“Creative Science. Advancing Medicine.” Was the theme for the AAPM 2021, which focused on exploring ways to bring creativity and scientific expertise to the medicine of the future. 

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Improving Department Results by Using Single Exposure Dual-energy Subtraction X-ray

A Webinar Held by
Dr. Karim S. Karim and Jay Potipcoe

KA Imaging presented a
webinar on July 27 to clarify the uses of dual-energy subtraction X-ray and
explain the limitations of old techniques. Using dual energy has many clinical
benefits as well as operational and financial.

Dr. Karim S. Karim, CTO
of KA Imaging, explained how global issues such as lung cancer, pneumothorax,
tuberculosis, and pneumonia (including COVID-19) have increased the need for
clearer images and more efficient processes in hospitals.

Traditional X-ray and
current dual-energy technologies have significant problems that are detailed in
this presentation, and previous solutions that fell short. In the 1990’s
dual-layer detector technology provided an improvement, but still had poor dose
efficiency and poor image quality. In the 2000’s kVp switching had marginally
better dose efficiency, but still had motion artifacts contributing to poor
quality. In the 2010’s, bone suppression software provided good dose
efficiency, but limited views, and could not distinguish from bone and soft
tissue. In the 2020’s, a single-exposure dual-energy subtraction X-ray device
with triple-layer detector technology has shown excellent dose efficiency with
three sensor layers capturing more photons, and excellent image quality with no
motion artifacts.

KA Imaging’s Reveal™ 35C provides this solution. With just
one exposure, the detector simultaneously delivers DR, bone, and tissue images
with no motion artifacts. Not limited to one-use cases, like bone suppression
software, it can be used just as a regular chest X-ray, adding new potential
use cases like cardiac ones. It is FDA 510(k) cleared and Health Canada
approved, with promising initial results shown from clinical trials.

After the webinar, some attendees elected to participate in
a survey and 95% of respondents were more than satisfied with the results. Some
reported learning “lots,” “a good amount of new information,” and “quite a
bit!” In fact, the majority of respondents felt this technology was a
“must-have” solution. “I would like to offer it to my clients right NOW,” wrote
one respondent.

This presentation is available on-demand and is approved by
AHRA for 1.0 Category A AART credit. Learn more about single exposure
dual-energy subtraction X-ray solutions now: https://theicecommunity.com/webinar/improving-department-results-with-single-exposure-dual-energy-subtraction-x-ray-clinical-operational-and-financial-benefits/

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Cutting-Edge Equine X-ray Detector May be the New Jewel of the Triple Crown

In a sport where the athletes running for glory are often separated by tenths of a second, every advantage counts. Optimal health must peak at precise times, and those tasked with the care of these delicate contestants must leverage every resource available to be competitive.
 

Bowed tendons, splints, sesamoid, knee and condylar fractures, bucked shins, and bone chips in knee or fetlock are only the short list. A host of soft tissue injuries can also occur where limited blood flow makes early diagnosis tricky, since heat and swelling may not even occur to signal issues. Tendon and ligament injuries that intermittently flare can go unnoticed until damage is severe. 

Enter Reveal™ 35C, Waterloo Ontario Canada’s answer to early detection of both bone and soft-tissue damage in elite equine athletes.
 

“We have developed a portable color X-ray detector capable of generating both bone and soft-tissue images without motion artifacts, similar to dual exposure dual-energy systems,” said KA Imaging’s CTO and founder, Dr. Karim S. Karim. “This detector, however, is multi-energy, so is designed to obtain a multi-energy X-ray image and very high DQE digital radiography images from a single exposure.” 

Screening using dual energy X-ray imaging has been around for forty years, however, it has suffered from performance issues limiting its adoption. Dual-energy X-ray machines demand that a veterinarian bring the horse to a fixed radiology room to obtain two images of each target area: one for bone, one for soft tissue. The horse can move frequently during the required time and the shots become motion-blurred, forcing retakes. 
 

Single shot imaging, a key component of multi-energy X-ray systems, helps to eliminate motion artifacts by reducing the time needed to acquire one exposure. Clear, unblurred, images can now be used for diagnosis where bone and soft tissue images are differentiated but maintain the same perspective view.
 

Using Reveal 35C’s multi-energy functionality, the veterinarian can potentially eliminate the need for other diagnostic procedures such as MRI and ultrasound, eliminating the need to sedate the horse and reducing time-sensitive diagnostic deliberation when immediate action could be critical.
 

Routine maintenance is the area where Reveal™ 35C could really shine. Were it incorporated into regular check-ups, since the time required for its use is minimal, a precise record of the ongoing musculoskeletal development and condition of each athlete could be maintained, thereby hopefully catching latent issues prior to full manifestation, allowing training regimens and racing schedules to be altered before injury occurs. A prime example is early diagnosis of synovitis, which may be caused by minute bone or cartilage fragments or fractures that when caught and repaired early, prevent the development of synovitis in the first place. 

“The best vets in the racehorse industry will adopt new practices designed to prevent or quickly catch issues in the legs of racehorses, not just in preservation of an ancient and undeniably exciting sport, but mostly for the love of the horse, the real reason the sport is great and has persevered,” Karim said. “Reveal™ 35C is ideally suited for this purpose, with its rugged construction, and its ability to function in alternate acquisition mode in barns where the Wi–Fi signal may be weak in certain areas.”
 

Reveal™ 35C is also lightweight for portability, and its low-dose radiation operation is beneficial to the veterinary doctor—and also the animal—allowing for regular use. 

 

About KA Imaging 

A spin-off from the University of Waterloo, KA Imaging is a Canadian company that specializes in developing innovative X-ray imaging technologies and systems, providing solutions to the medical, veterinary and NDT markets. The company has successfully developed a line of innovative X-ray imaging products in the areas of phase contrast micro-computed tomography, ultra-high spatial resolution X-ray detectors and large area digital, dual-energy X-ray material separation detectors. 

  35C

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InCiTe™ micro-CT and Manufacturing

Why are bubbles a problem? When manufacturing parts, there is always a chance of pores or holes forming within them during the process. Voids can affect the quality of goods being manufactured, and this is a big concern. In die casting, for example, air can be trapped in molds and cause bubbles inside the molten […]

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KA Imaging Awarded Technology Breakthrough Agreement with Premier Inc.

FOR IMMEDIATE RELEASE

WATERLOO, ON– July 20, 2021 – KA Imaging has been awarded a group purchasing agreement for a Technology Breakthrough with Premier Inc. Effective July 1, 2021, the new agreement allows Premier members, at their discretion, to take advantage of special pricing and terms pre-negotiated by Premier for Reveal™ 35C, in the product category of General Radiography (Radiography, Radiography and Fluoroscopy, Portable Radiography).
  

“The Technology Program was designed to ensure that Premier’s members can access innovative products that drive high-quality and cost-effective care,” explained Amol Karnick, President and CEO of KA Imaging. “Being accepted through this program is an important step for Reveal. We made a detector that overcomes previous dual-energy technology shortfalls and is retrofittable, which means that any hospital can access the clinical and operational benefits of Reveal with minimum financial impact,” said Mr. Karnick. 

Reveal 35C is the world’s first mobile/portable FDA 510(k) cleared dual-energy X-ray detector. Its patented triple-layer design enables the production of three images from just one shot – traditional DR, bone, and tissue only images, with no motion artifacts. Reveal is currently being used in two clinical trials, for lung cancer and pneumonia, with great initial success.
  

Premier is a leading technology-driven healthcare improvement company, uniting an alliance of more than 4,100 U.S. hospitals and 200,000 other providers and organizations to transform healthcare. With integrated data and analytics, collaboratives, supply chain solutions, and consulting and other services, Premier enables better care and outcomes at a lower cost. 

About KA Imaging 

A spin-off from the University of Waterloo, KA Imaging specializes in developing innovative X-ray imaging technologies and systems, providing solutions to the medical, veterinary, and non-destructive test industrial markets. For more information, please visit www.kaimaging.com. 

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Reveal™ 35C: Testimonial from Medical Imaging Technologists

Watch now, as medical imaging technologists Sandeep Ronghe and Mary May discuss using Reveal 35C for medical imaging.

They are very excited about the benefits for a hospital’s ICU population, including those currently suffering from COVID-19 and/or pneumonia, due to the mobility of the unit.

The image quality, portability, and use of just one exposure make Reveal 35C an ideal choice for medical imaging technologists. 

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7 Reasons Why Radiology is important

  1. 1. Images can help diagnose disease
     

Early diagnosis is known to save lives, and having high-quality images taken at the first sign of a problem can make a huge difference. An average of eight people a day are diagnosed with cancer in Ontario alone, and doctors rely on tests to recommend treatment. 

  1. 2. Images can help detect injuries
     

Bone X-rays are the fastest and easiest way for a doctor to assess fractures, injuries, and joint abnormalities. They use a very small does of ionizing radiation and can produce pictures of any bone in your body. 
 

  1. 3. Diseases can be managed through image comparison
     

Imaging can provide detailed information about structural or disease-related changes. It is important to follow up with new images when requested by your doctor so they can watch for advancements or improvements and plan your treatment accordingly.
 

  1. 4. Family and emergency doctors depend on radiology tests to determine treatment 

In emergent situations, getting information quickly might be critical for a patient’s treatment and recovery. All doctors want the most detailed images and test results to be able to diagnose their patients effectively.
 

  1. 5. Images can help determine when surgeries are necessary 

In some circumstances, it would be very difficult to determine if a surgery is needed or not at all. A doctor cannot tell the seriousness of an internal injury or unseen disease-related changes without a clear internal view of their patient. Also, triaging patients based on their needs is an integral part of our healthcare system. 

  1. 6. They reduce the need for exploratory surgeries
     

Having clear internal images to diagnose presenting problems might not only determine and the actual issue but prevent unneeded surgeries in some cases. Or it can specify the surgery needed and help to determine the best specialist for the patient.
 

  1. 7. They reduce the length of hospitalizations
     

Medical imaging can show improvements and give doctors a better idea how a patient is healing post-surgery or treatment. This can lead to an earlier release and less unneeded time in hospital for a patient, benefitting not only this particular patient, but another who might need treatment as well. Earlier release of recovering patients frees up hospital space and the care providers’ time, so they can ultimately help more people. 

 

 

References 

Benefits of Imaging Using Radiation. UCSF Department of Radiology & Biomedical Imaging. https://radiology.ucsf.edu/patient-care/patient-safety/radiation-safety/benefits 

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